| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
285 |
125 |
$236K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
72 |
55 |
$61K |
| D4342 |
|
439 |
113 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
364 |
341 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
39 |
$14K |
| D3320 |
|
14 |
13 |
$11K |
| D0330 |
Panoramic radiographic image |
355 |
334 |
$10K |
| D0272 |
Bitewings - two radiographic images |
310 |
298 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
344 |
326 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
342 |
325 |
$6K |
| D4341 |
|
32 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
38 |
$3K |
| D9110 |
|
22 |
21 |
$651.18 |
| D0367 |
|
15 |
15 |
$290.00 |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
38 |
$0.00 |
| D0191 |
|
118 |
112 |
$0.00 |
| D0190 |
|
118 |
112 |
$0.00 |