| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
262 |
252 |
$8K |
| D0330 |
Panoramic radiographic image |
137 |
128 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
32 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$699.60 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$622.50 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$595.65 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$515.23 |
| D0220 |
Intraoral - periapical first radiographic image |
20 |
17 |
$188.00 |