| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
412 |
386 |
$15K |
| D0274 |
Bitewings - four radiographic images |
471 |
445 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
271 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,511 |
491 |
$8K |
| D1206 |
Topical application of fluoride varnish |
216 |
199 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
43 |
$7K |
| D1120 |
Prophylaxis - child |
157 |
147 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
469 |
440 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
162 |
151 |
$4K |
| D1351 |
Sealant - per tooth |
242 |
24 |
$3K |
| D4355 |
|
27 |
27 |
$595.00 |
| D0120 |
Periodic oral evaluation - established patient |
26 |
26 |
$470.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
17 |
$276.70 |
| D0602 |
|
17 |
15 |
$75.00 |