| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
666 |
617 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
638 |
595 |
$20K |
| D1351 |
Sealant - per tooth |
1,020 |
130 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
282 |
72 |
$12K |
| D1120 |
Prophylaxis - child |
317 |
278 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
314 |
62 |
$9K |
| D1206 |
Topical application of fluoride varnish |
244 |
219 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
198 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
305 |
271 |
$3K |
| D0274 |
Bitewings - four radiographic images |
102 |
81 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
113 |
103 |
$2K |
| D7311 |
|
30 |
12 |
$2K |
| D1110 |
Prophylaxis - adult |
83 |
77 |
$2K |
| D4355 |
|
98 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
259 |
222 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
76 |
61 |
$583.68 |