| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
755 |
733 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
377 |
340 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,092 |
1,092 |
$17K |
| D0330 |
Panoramic radiographic image |
201 |
197 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
350 |
324 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
223 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
300 |
281 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
34 |
$3K |
| D1120 |
Prophylaxis - child |
659 |
659 |
$3K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$1K |
| D1351 |
Sealant - per tooth |
12 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
55 |
55 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
710 |
710 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
28 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
268 |
268 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
39 |
$0.00 |