| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,541 |
1,142 |
$152K |
| D1110 |
Prophylaxis - adult |
2,877 |
2,781 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,371 |
3,288 |
$80K |
| D1120 |
Prophylaxis - child |
1,778 |
1,747 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,104 |
1,596 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,065 |
2,021 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,147 |
3,061 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
849 |
644 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
803 |
$45K |
| D1206 |
Topical application of fluoride varnish |
777 |
768 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
689 |
664 |
$21K |
| D2332 |
|
85 |
59 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
100 |
69 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
66 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
302 |
287 |
$3K |
| D2140 |
|
18 |
14 |
$1K |
| D2330 |
|
12 |
12 |
$588.88 |