| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,277 |
5,274 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
7,432 |
7,424 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
4,282 |
4,240 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,321 |
1,321 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,847 |
2,826 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
417 |
413 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
962 |
961 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
102 |
$7K |
| D1120 |
Prophylaxis - child |
211 |
210 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$485.18 |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$478.34 |