| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
187 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
294 |
80 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
598 |
593 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
495 |
494 |
$19K |
| D2740 |
Crown - porcelain/ceramic |
33 |
29 |
$18K |
| D2950 |
|
143 |
97 |
$16K |
| D1110 |
Prophylaxis - adult |
300 |
300 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
238 |
229 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
766 |
753 |
$11K |
| D3320 |
|
15 |
12 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
247 |
247 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
26 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
26 |
$5K |
| D1206 |
Topical application of fluoride varnish |
158 |
158 |
$4K |
| D0274 |
Bitewings - four radiographic images |
132 |
132 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
383 |
344 |
$3K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$1K |