| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
574 |
406 |
$172K |
| D1120 |
Prophylaxis - child |
1,735 |
1,645 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
762 |
518 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,727 |
1,662 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
435 |
311 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,058 |
986 |
$26K |
| D1351 |
Sealant - per tooth |
364 |
180 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,575 |
1,483 |
$24K |
| D2950 |
|
336 |
240 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,142 |
1,041 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,323 |
2,967 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,659 |
3,419 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
268 |
203 |
$18K |
| D3310 |
|
100 |
64 |
$17K |
| D1206 |
Topical application of fluoride varnish |
644 |
628 |
$16K |
| D1110 |
Prophylaxis - adult |
360 |
343 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
699 |
666 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
172 |
115 |
$5K |
| D0272 |
Bitewings - two radiographic images |
608 |
572 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
62 |
$5K |
| D2331 |
|
85 |
59 |
$5K |
| D0270 |
|
81 |
68 |
$380.80 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
28 |
$227.50 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$203.40 |
| D0603 |
|
349 |
319 |
$108.00 |
| D0601 |
|
413 |
379 |
$54.00 |
| D0602 |
|
209 |
181 |
$0.00 |
| D1330 |
|
120 |
111 |
$0.00 |