| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,506 |
1,170 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,642 |
1,385 |
$26K |
| D0330 |
Panoramic radiographic image |
770 |
537 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
423 |
84 |
$18K |
| D0274 |
Bitewings - four radiographic images |
709 |
594 |
$14K |
| D1120 |
Prophylaxis - child |
570 |
425 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
40 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
214 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
25 |
$5K |
| D1206 |
Topical application of fluoride varnish |
214 |
196 |
$5K |
| D1351 |
Sealant - per tooth |
126 |
16 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
225 |
76 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
41 |
40 |
$1K |
| D0272 |
Bitewings - two radiographic images |
69 |
14 |
$121.80 |
| D1999 |
|
1,760 |
1,608 |
$0.00 |
| D9630 |
|
862 |
809 |
$0.00 |