| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
147 |
84 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
195 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
224 |
98 |
$13K |
| D2950 |
|
98 |
54 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
21 |
16 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
141 |
49 |
$9K |
| D1110 |
Prophylaxis - adult |
296 |
290 |
$8K |
| D0601 |
|
216 |
207 |
$7K |
| D9999 |
Unspecified adjunctive procedure, by report |
57 |
57 |
$3K |
| D1351 |
Sealant - per tooth |
506 |
94 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
30 |
27 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
370 |
354 |
$979.64 |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$953.45 |
| D1120 |
Prophylaxis - child |
26 |
25 |
$476.00 |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
169 |
$424.00 |
| D0274 |
Bitewings - four radiographic images |
62 |
60 |
$193.00 |
| D1330 |
|
351 |
333 |
$173.00 |
| D0220 |
Intraoral - periapical first radiographic image |
126 |
116 |
$76.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
31 |
$0.00 |