| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
228 |
120 |
$19K |
| D1110 |
Prophylaxis - adult |
388 |
388 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
500 |
500 |
$12K |
| D1206 |
Topical application of fluoride varnish |
431 |
429 |
$11K |
| D0274 |
Bitewings - four radiographic images |
439 |
439 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
264 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
65 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
751 |
726 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
900 |
447 |
$5K |
| D0330 |
Panoramic radiographic image |
116 |
116 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
97 |
97 |
$2K |
| D1120 |
Prophylaxis - child |
39 |
39 |
$1K |
| D1999 |
|
101 |
96 |
$1K |
| D0270 |
|
12 |
12 |
$157.56 |
| D9986 |
|
99 |
96 |
$0.00 |