| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,118 |
977 |
$32K |
| D0330 |
Panoramic radiographic image |
1,060 |
984 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
448 |
421 |
$23K |
| D1120 |
Prophylaxis - child |
519 |
492 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,347 |
1,055 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,290 |
1,163 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
468 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
485 |
444 |
$10K |
| D1206 |
Topical application of fluoride varnish |
223 |
215 |
$7K |
| D0274 |
Bitewings - four radiographic images |
323 |
302 |
$7K |
| D1110 |
Prophylaxis - adult |
140 |
125 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
308 |
285 |
$3K |
| D1351 |
Sealant - per tooth |
98 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
13 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
16 |
16 |
$480.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
16 |
16 |
$320.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$269.10 |