| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
118 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
446 |
416 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
573 |
559 |
$3K |
| D1120 |
Prophylaxis - child |
391 |
381 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
472 |
412 |
$1K |
| D1110 |
Prophylaxis - adult |
197 |
195 |
$825.75 |
| D0120 |
Periodic oral evaluation - established patient |
254 |
250 |
$747.82 |
| D0274 |
Bitewings - four radiographic images |
286 |
274 |
$575.15 |
| D1206 |
Topical application of fluoride varnish |
248 |
244 |
$514.18 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$308.22 |
| D0330 |
Panoramic radiographic image |
196 |
183 |
$189.53 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$91.81 |
| D0272 |
Bitewings - two radiographic images |
54 |
52 |
$91.05 |