| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
568 |
325 |
$45K |
| D1110 |
Prophylaxis - adult |
1,115 |
1,113 |
$40K |
| D9243 |
|
327 |
312 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,474 |
1,470 |
$29K |
| D0274 |
Bitewings - four radiographic images |
986 |
986 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,117 |
1,115 |
$19K |
| D0330 |
Panoramic radiographic image |
490 |
481 |
$12K |
| D0160 |
|
277 |
274 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
124 |
$2K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
32 |
$181.36 |