| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
25 |
$15K |
| D1110 |
Prophylaxis - adult |
79 |
77 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
45 |
44 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
41 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
18 |
18 |
$677.10 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$555.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$250.10 |