| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
208 |
144 |
$147K |
| D1110 |
Prophylaxis - adult |
1,338 |
1,219 |
$70K |
| D4342 |
|
584 |
194 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
618 |
328 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
569 |
538 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
263 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
779 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
979 |
868 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,118 |
971 |
$18K |
| D0274 |
Bitewings - four radiographic images |
386 |
345 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
439 |
394 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
231 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
653 |
564 |
$9K |
| D1120 |
Prophylaxis - child |
146 |
144 |
$8K |