| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
494 |
457 |
$39K |
| D2740 |
Crown - porcelain/ceramic |
26 |
15 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,276 |
1,124 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
73 |
68 |
$9K |
| D0274 |
Bitewings - four radiographic images |
457 |
421 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
103 |
94 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,079 |
532 |
$8K |
| D1110 |
Prophylaxis - adult |
228 |
209 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25 |
13 |
$2K |
| D2950 |
|
44 |
28 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$759.10 |