| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
6,364 |
5,677 |
$177K |
| D0210 |
Intraoral - complete series of radiographic images |
2,758 |
2,514 |
$136K |
| D1120 |
Prophylaxis - child |
2,757 |
2,502 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,814 |
899 |
$104K |
| D1206 |
Topical application of fluoride varnish |
2,628 |
2,389 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,732 |
3,437 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,340 |
638 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,889 |
4,450 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,613 |
1,460 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,984 |
4,275 |
$28K |
| D1351 |
Sealant - per tooth |
1,192 |
171 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
578 |
333 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,101 |
1,001 |
$20K |
| D0330 |
Panoramic radiographic image |
988 |
637 |
$17K |
| D1110 |
Prophylaxis - adult |
957 |
869 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
291 |
97 |
$11K |
| D8660 |
|
327 |
277 |
$11K |
| D0340 |
|
594 |
315 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
130 |
80 |
$8K |
| D0350 |
|
718 |
392 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
132 |
132 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
47 |
47 |
$1K |
| D1999 |
|
86 |
86 |
$1K |
| D7111 |
|
45 |
25 |
$1K |
| D9310 |
|
243 |
193 |
$492.00 |
| D0170 |
|
12 |
12 |
$221.28 |
| D0191 |
|
21 |
13 |
$51.20 |