| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
2,569 |
825 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
724 |
398 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
561 |
545 |
$3K |
| D7240 |
Removal of impacted tooth - completely bony |
123 |
57 |
$1K |
| D1120 |
Prophylaxis - child |
46 |
46 |
$270.00 |
| D0120 |
Periodic oral evaluation - established patient |
46 |
45 |
$190.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
52 |
51 |
$130.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$60.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$50.00 |
| D1999 |
|
75 |
74 |
$0.00 |