| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,745 |
2,480 |
$255K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,710 |
1,024 |
$109K |
| D2160 |
|
823 |
608 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,523 |
2,438 |
$47K |
| D0330 |
Panoramic radiographic image |
2,346 |
2,256 |
$44K |
| D1110 |
Prophylaxis - adult |
1,967 |
1,910 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
6,352 |
6,006 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,518 |
3,415 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,718 |
1,667 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
2,041 |
$38K |
| D0274 |
Bitewings - four radiographic images |
2,870 |
2,773 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,940 |
4,221 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
487 |
185 |
$21K |
| D4341 |
|
484 |
222 |
$17K |
| D2332 |
|
154 |
95 |
$13K |
| D1120 |
Prophylaxis - child |
459 |
453 |
$12K |
| D2140 |
|
199 |
153 |
$8K |
| D3320 |
|
14 |
12 |
$4K |
| D4342 |
|
62 |
39 |
$4K |
| D4910 |
|
26 |
26 |
$1K |
| D0240 |
|
61 |
43 |
$1K |
| D2331 |
|
15 |
12 |
$952.00 |
| D1999 |
|
104 |
67 |
$728.00 |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$623.50 |
| D0180 |
|
249 |
234 |
$213.00 |
| D0602 |
|
58 |
54 |
$0.00 |
| D1310 |
|
329 |
317 |
$0.00 |
| D1330 |
|
328 |
318 |
$0.00 |
| D0603 |
|
32 |
30 |
$0.00 |
| D0601 |
|
170 |
168 |
$0.00 |