| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,517 |
459 |
$172K |
| D0140 |
Limited oral evaluation - problem focused |
1,819 |
1,717 |
$57K |
| D9310 |
|
694 |
673 |
$41K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
451 |
419 |
$34K |
| D1206 |
Topical application of fluoride varnish |
606 |
577 |
$30K |
| D1120 |
Prophylaxis - child |
514 |
492 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,324 |
1,278 |
$23K |
| D0330 |
Panoramic radiographic image |
600 |
580 |
$22K |
| D9222 |
|
443 |
421 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,915 |
1,670 |
$21K |
| D0274 |
Bitewings - four radiographic images |
946 |
908 |
$21K |
| D7220 |
|
124 |
63 |
$16K |
| D7240 |
Removal of impacted tooth - completely bony |
118 |
55 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
246 |
$14K |
| D1351 |
Sealant - per tooth |
506 |
89 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
371 |
364 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
102 |
$3K |
| D4355 |
|
12 |
12 |
$823.13 |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$360.00 |
| D0601 |
|
69 |
66 |
$253.80 |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$240.00 |
| D0603 |
|
13 |
13 |
$63.25 |