| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
204 |
190 |
$154K |
| D1110 |
Prophylaxis - adult |
1,717 |
1,716 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
607 |
523 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,201 |
2,199 |
$60K |
| D1120 |
Prophylaxis - child |
963 |
963 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,183 |
1,124 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
994 |
994 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,010 |
1,010 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,486 |
1,486 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,492 |
1,396 |
$19K |
| D0330 |
Panoramic radiographic image |
456 |
456 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
154 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
122 |
$13K |
| D2954 |
|
77 |
70 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
81 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
70 |
65 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
501 |
478 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
41 |
$4K |
| D2160 |
|
26 |
26 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
152 |
$2K |
| D1351 |
Sealant - per tooth |
12 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
99 |
99 |
$2K |
| D2140 |
|
13 |
12 |
$827.20 |
| D4910 |
|
15 |
15 |
$763.28 |
| D1999 |
|
19 |
18 |
$0.00 |