| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D4341 |
|
1,052 |
516 |
$236K |
| D2740 |
Crown - porcelain/ceramic |
674 |
566 |
$210K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,150 |
899 |
$99K |
| D1120 |
Prophylaxis - child |
2,271 |
2,174 |
$93K |
| D1351 |
Sealant - per tooth |
943 |
463 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
854 |
672 |
$73K |
| D9110 |
|
1,332 |
1,273 |
$72K |
| D2950 |
|
886 |
755 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,336 |
2,273 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,275 |
2,182 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,481 |
2,361 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,054 |
2,945 |
$55K |
| D1110 |
Prophylaxis - adult |
925 |
904 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,757 |
1,614 |
$32K |
| D4342 |
|
130 |
90 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,225 |
2,931 |
$18K |
| D2332 |
|
103 |
69 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,770 |
1,636 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
102 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
70 |
$8K |
| D2335 |
|
15 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
105 |
103 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
77 |
$892.18 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$351.58 |