| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
382 |
366 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
483 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
272 |
117 |
$12K |
| D1351 |
Sealant - per tooth |
434 |
59 |
$9K |
| D0274 |
Bitewings - four radiographic images |
332 |
324 |
$7K |
| D1120 |
Prophylaxis - child |
120 |
120 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
397 |
386 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
27 |
$3K |
| D1110 |
Prophylaxis - adult |
120 |
118 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
417 |
356 |
$2K |
| D0160 |
|
53 |
51 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
44 |
43 |
$727.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
53 |
$566.15 |
| D1206 |
Topical application of fluoride varnish |
14 |
13 |
$110.25 |