| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
7,750 |
4,139 |
$85K |
| D2740 |
Crown - porcelain/ceramic |
178 |
133 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,553 |
1,548 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,261 |
1,261 |
$78K |
| D1120 |
Prophylaxis - child |
1,940 |
1,931 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,696 |
2,685 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,005 |
1,005 |
$47K |
| D4910 |
|
535 |
534 |
$41K |
| D4341 |
|
388 |
103 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,693 |
1,686 |
$18K |
| D1110 |
Prophylaxis - adult |
150 |
150 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
849 |
841 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
79 |
$7K |
| D9430 |
|
228 |
226 |
$7K |
| D0272 |
Bitewings - two radiographic images |
324 |
324 |
$4K |
| D1351 |
Sealant - per tooth |
90 |
16 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |