| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
796 |
731 |
$22K |
| D1120 |
Prophylaxis - child |
527 |
488 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
226 |
134 |
$20K |
| D4341 |
|
102 |
47 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
166 |
107 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
379 |
348 |
$10K |
| D0274 |
Bitewings - four radiographic images |
376 |
342 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
38 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
696 |
608 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
463 |
412 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
183 |
161 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
54 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
27 |
$648.00 |
| D1110 |
Prophylaxis - adult |
14 |
13 |
$574.00 |