| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
227 |
223 |
$11K |
| D1110 |
Prophylaxis - adult |
297 |
293 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
41 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
279 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
39 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
222 |
221 |
$4K |
| D1120 |
Prophylaxis - child |
140 |
140 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
235 |
233 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
134 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
26 |
$2K |
| D0274 |
Bitewings - four radiographic images |
68 |
66 |
$2K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$879.76 |