| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
313 |
303 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
99 |
98 |
$2K |
| D1110 |
Prophylaxis - adult |
51 |
49 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
59 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$973.60 |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$910.16 |
| D0230 |
Intraoral - periapical each additional radiographic image |
145 |
85 |
$857.93 |
| D1120 |
Prophylaxis - child |
27 |
27 |
$656.10 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$254.32 |