| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
211 |
137 |
$55K |
| D1120 |
Prophylaxis - child |
577 |
568 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
658 |
646 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
449 |
142 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
446 |
437 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
389 |
386 |
$8K |
| D1110 |
Prophylaxis - adult |
202 |
201 |
$8K |
| D0274 |
Bitewings - four radiographic images |
441 |
435 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
211 |
208 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
354 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
525 |
491 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$647.85 |
| D0272 |
Bitewings - two radiographic images |
57 |
57 |
$535.80 |