| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,477 |
2,152 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,056 |
848 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,602 |
1,332 |
$37K |
| D1120 |
Prophylaxis - child |
928 |
773 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,168 |
1,052 |
$24K |
| D1351 |
Sealant - per tooth |
1,375 |
167 |
$23K |
| D1110 |
Prophylaxis - adult |
1,004 |
860 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,393 |
1,233 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
920 |
772 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
154 |
60 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
142 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
135 |
106 |
$2K |
| D0601 |
|
539 |
496 |
$2K |
| D9110 |
|
64 |
59 |
$2K |
| D2140 |
|
81 |
12 |
$1K |