| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
747 |
396 |
$354K |
| D0120 |
Periodic oral evaluation - established patient |
2,070 |
2,064 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,576 |
1,574 |
$96K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
748 |
337 |
$85K |
| D1120 |
Prophylaxis - child |
1,569 |
1,564 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
1,166 |
1,163 |
$52K |
| D9430 |
|
1,434 |
1,382 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
546 |
337 |
$36K |
| D2954 |
|
335 |
229 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,744 |
1,741 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,057 |
2,613 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
44 |
37 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,410 |
1,390 |
$17K |
| D2140 |
|
144 |
95 |
$8K |
| D4341 |
|
84 |
25 |
$6K |
| D3320 |
|
15 |
12 |
$5K |
| D0350 |
|
440 |
261 |
$4K |
| D1351 |
Sealant - per tooth |
102 |
25 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
20 |
20 |
$2K |
| D4910 |
|
17 |
17 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$390.00 |