| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,395 |
863 |
$94K |
| D0330 |
Panoramic radiographic image |
1,649 |
1,629 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,805 |
2,774 |
$66K |
| D1120 |
Prophylaxis - child |
1,244 |
1,238 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,314 |
1,304 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,258 |
1,240 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,959 |
1,942 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,924 |
2,889 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,561 |
3,600 |
$28K |
| D1110 |
Prophylaxis - adult |
1,295 |
1,279 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,212 |
1,206 |
$12K |
| D1351 |
Sealant - per tooth |
216 |
51 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
36 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
108 |
108 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$947.10 |
| D1999 |
|
19 |
19 |
$285.00 |