| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
479 |
166 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
438 |
235 |
$23K |
| D1110 |
Prophylaxis - adult |
545 |
545 |
$18K |
| D1206 |
Topical application of fluoride varnish |
821 |
819 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
674 |
670 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
440 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
225 |
120 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
188 |
$10K |
| D0330 |
Panoramic radiographic image |
246 |
244 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
411 |
407 |
$9K |
| D1120 |
Prophylaxis - child |
434 |
432 |
$8K |
| D0274 |
Bitewings - four radiographic images |
392 |
391 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
59 |
45 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
647 |
628 |
$3K |
| D2335 |
|
30 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
460 |
226 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
130 |
129 |
$1K |