| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
571 |
559 |
$17K |
| D1110 |
Prophylaxis - adult |
248 |
248 |
$17K |
| D1206 |
Topical application of fluoride varnish |
616 |
604 |
$15K |
| D1120 |
Prophylaxis - child |
261 |
252 |
$12K |
| D0330 |
Panoramic radiographic image |
234 |
234 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
191 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
183 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
19 |
14 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
28 |
$7K |
| D0274 |
Bitewings - four radiographic images |
274 |
269 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
14 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
190 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
253 |
238 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
31 |
31 |
$373.92 |
| D1330 |
|
14 |
14 |
$100.80 |