| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
214 |
213 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
111 |
47 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
368 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
86 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
35 |
$6K |
| D1110 |
Prophylaxis - adult |
130 |
129 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
47 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
105 |
105 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
157 |
157 |
$3K |
| D2394 |
|
24 |
13 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
63 |
63 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
109 |
$1K |
| D1120 |
Prophylaxis - child |
17 |
17 |
$569.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
29 |
$283.09 |