| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
424 |
182 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
401 |
387 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
292 |
171 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
179 |
$24K |
| D1110 |
Prophylaxis - adult |
460 |
450 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
684 |
669 |
$21K |
| D0274 |
Bitewings - four radiographic images |
297 |
285 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
35 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
583 |
546 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
379 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
209 |
$5K |
| D1120 |
Prophylaxis - child |
159 |
154 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
177 |
174 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
157 |
152 |
$3K |
| D2330 |
|
20 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$582.12 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$241.80 |