| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
268 |
164 |
$15K |
| D0999 |
Unspecified diagnostic procedure, by report |
374 |
205 |
$13K |
| D1120 |
Prophylaxis - child |
221 |
187 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
78 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
40 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
80 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
26 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
65 |
47 |
$1K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$205.90 |
| D1206 |
Topical application of fluoride varnish |
193 |
163 |
$205.90 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
43 |
$0.00 |