| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
724 |
723 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
158 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
207 |
206 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
836 |
813 |
$9K |
| D0274 |
Bitewings - four radiographic images |
212 |
212 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
170 |
169 |
$5K |
| D1110 |
Prophylaxis - adult |
100 |
100 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
25 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
225 |
225 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
345 |
321 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
29 |
$2K |
| D1120 |
Prophylaxis - child |
20 |
20 |
$637.92 |
| D9110 |
|
12 |
12 |
$614.45 |