| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,158 |
866 |
$551K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
786 |
733 |
$361K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,317 |
2,303 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,792 |
875 |
$118K |
| D2954 |
|
996 |
836 |
$104K |
| D9430 |
|
3,289 |
2,950 |
$103K |
| D0350 |
|
3,280 |
3,215 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
2,064 |
2,052 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
675 |
415 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
713 |
711 |
$52K |
| D1110 |
Prophylaxis - adult |
515 |
511 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,836 |
2,741 |
$41K |
| D1120 |
Prophylaxis - child |
778 |
772 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
641 |
335 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
262 |
153 |
$31K |
| D4341 |
|
419 |
108 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
513 |
454 |
$20K |
| D0274 |
Bitewings - four radiographic images |
852 |
847 |
$18K |
| D1206 |
Topical application of fluoride varnish |
774 |
767 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
535 |
533 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
388 |
$5K |
| D0330 |
Panoramic radiographic image |
122 |
122 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
26 |
$3K |
| D0270 |
|
600 |
597 |
$3K |
| D2931 |
|
20 |
16 |
$3K |
| D0272 |
Bitewings - two radiographic images |
184 |
184 |
$2K |
| D0180 |
|
506 |
503 |
$0.00 |
| D1330 |
|
488 |
480 |
$0.00 |