| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D9430 |
|
1,153 |
910 |
$37K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
12 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
228 |
226 |
$8K |
| D4910 |
|
98 |
96 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
651 |
648 |
$6K |
| D1120 |
Prophylaxis - child |
242 |
242 |
$6K |
| D1110 |
Prophylaxis - adult |
80 |
80 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,040 |
454 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
86 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
81 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
237 |
222 |
$2K |
| D0274 |
Bitewings - four radiographic images |
99 |
99 |
$2K |
| D0350 |
|
164 |
77 |
$1K |
| D1330 |
|
204 |
202 |
$0.00 |
| D1310 |
|
214 |
211 |
$0.00 |