| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
797 |
768 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,033 |
955 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
517 |
493 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
169 |
86 |
$5K |
| D0274 |
Bitewings - four radiographic images |
337 |
329 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
283 |
271 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
598 |
549 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
76 |
$3K |
| D9110 |
|
122 |
109 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
79 |
$884.30 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$419.10 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$150.78 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$96.55 |
| D1999 |
|
38 |
33 |
$0.00 |