| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,539 |
596 |
$110K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
326 |
273 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
2,021 |
1,847 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,527 |
769 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,524 |
515 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,381 |
2,203 |
$43K |
| D1110 |
Prophylaxis - adult |
1,626 |
1,484 |
$39K |
| D0330 |
Panoramic radiographic image |
1,332 |
1,225 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,930 |
1,792 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
493 |
371 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
531 |
338 |
$18K |
| D3320 |
|
61 |
43 |
$10K |
| D1351 |
Sealant - per tooth |
686 |
79 |
$10K |
| D1120 |
Prophylaxis - child |
555 |
514 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,553 |
1,361 |
$10K |
| D0274 |
Bitewings - four radiographic images |
761 |
699 |
$9K |
| D1206 |
Topical application of fluoride varnish |
767 |
682 |
$8K |
| D9110 |
|
275 |
254 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,835 |
830 |
$5K |
| D2931 |
|
58 |
43 |
$5K |
| D2332 |
|
92 |
56 |
$4K |
| D2394 |
|
31 |
26 |
$2K |
| D2331 |
|
51 |
29 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
111 |
104 |
$2K |
| D4355 |
|
20 |
16 |
$704.51 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$193.35 |