| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,774 |
1,844 |
$217K |
| D0330 |
Panoramic radiographic image |
2,380 |
2,355 |
$101K |
| D1110 |
Prophylaxis - adult |
2,178 |
2,159 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,156 |
3,126 |
$88K |
| D0272 |
Bitewings - two radiographic images |
2,254 |
2,237 |
$32K |
| D7250 |
|
140 |
80 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
249 |
$8K |
| D0274 |
Bitewings - four radiographic images |
213 |
212 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$182.25 |