| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
371 |
358 |
$348K |
| D2740 |
Crown - porcelain/ceramic |
92 |
56 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
765 |
760 |
$49K |
| D2950 |
|
231 |
176 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
782 |
777 |
$19K |
| D3320 |
|
14 |
12 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
179 |
179 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
121 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
29 |
$7K |
| D0270 |
|
547 |
544 |
$6K |
| D1110 |
Prophylaxis - adult |
85 |
85 |
$6K |
| D1206 |
Topical application of fluoride varnish |
41 |
41 |
$950.91 |
| D0367 |
|
113 |
112 |
$0.00 |
| D0364 |
|
327 |
323 |
$0.00 |