| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,573 |
1,547 |
$83K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,089 |
435 |
$57K |
| D1120 |
Prophylaxis - child |
1,247 |
1,209 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,536 |
1,521 |
$35K |
| D0160 |
|
1,643 |
1,349 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
521 |
228 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
733 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,742 |
1,719 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
836 |
719 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
317 |
171 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,869 |
1,616 |
$11K |
| D1351 |
Sealant - per tooth |
355 |
79 |
$7K |
| D1110 |
Prophylaxis - adult |
266 |
257 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
438 |
432 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
91 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
89 |
89 |
$3K |
| D4346 |
|
40 |
38 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
17 |
17 |
$2K |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$630.00 |
| D1999 |
|
12 |
12 |
$180.00 |