| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
574 |
539 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,365 |
1,177 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
720 |
684 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,959 |
1,699 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,830 |
1,372 |
$17K |
| D0330 |
Panoramic radiographic image |
424 |
412 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
910 |
786 |
$14K |
| D1120 |
Prophylaxis - child |
332 |
295 |
$12K |
| D1206 |
Topical application of fluoride varnish |
435 |
389 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
371 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
80 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
95 |
12 |
$2K |