| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
172 |
163 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
69 |
$8K |
| D1110 |
Prophylaxis - adult |
134 |
134 |
$7K |
| D2954 |
|
47 |
47 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
188 |
188 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
115 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
213 |
213 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
82 |
82 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
158 |
158 |
$2K |
| D0350 |
|
159 |
159 |
$2K |
| D0270 |
|
80 |
80 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
69 |
$850.22 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$327.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$168.00 |