| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
420 |
416 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
224 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
145 |
143 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
53 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
54 |
$6K |
| D1120 |
Prophylaxis - child |
204 |
203 |
$5K |
| D2140 |
|
34 |
24 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
190 |
$2K |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$2K |
| D0274 |
Bitewings - four radiographic images |
252 |
250 |
$2K |
| D1351 |
Sealant - per tooth |
218 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
318 |
$1K |
| D1206 |
Topical application of fluoride varnish |
285 |
283 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
59 |
$321.42 |