| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
653 |
629 |
$34K |
| D1351 |
Sealant - per tooth |
995 |
115 |
$22K |
| D1120 |
Prophylaxis - child |
309 |
296 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
450 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
401 |
389 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
229 |
91 |
$12K |
| D1206 |
Topical application of fluoride varnish |
340 |
325 |
$12K |
| D1110 |
Prophylaxis - adult |
450 |
431 |
$11K |
| D0274 |
Bitewings - four radiographic images |
459 |
437 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
624 |
600 |
$7K |
| D0160 |
|
146 |
137 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
603 |
498 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
58 |
56 |
$1K |