| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
767 |
285 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
444 |
441 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
504 |
495 |
$11K |
| D0330 |
Panoramic radiographic image |
270 |
266 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
350 |
344 |
$6K |
| D1110 |
Prophylaxis - adult |
110 |
109 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
46 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
77 |
77 |
$1K |