| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
379 |
311 |
$180K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,341 |
1,333 |
$88K |
| D0340 |
|
1,315 |
1,308 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,289 |
1,281 |
$61K |
| D1110 |
Prophylaxis - adult |
715 |
711 |
$59K |
| D0350 |
|
5,458 |
1,444 |
$51K |
| D9430 |
|
991 |
831 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
58 |
51 |
$27K |
| D2954 |
|
241 |
206 |
$25K |
| D0330 |
Panoramic radiographic image |
504 |
503 |
$15K |
| D1206 |
Topical application of fluoride varnish |
703 |
699 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
125 |
73 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
60 |
60 |
$5K |
| D1120 |
Prophylaxis - child |
36 |
36 |
$2K |
| D0274 |
Bitewings - four radiographic images |
61 |
61 |
$1K |
| D4910 |
|
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
79 |
$615.60 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$167.00 |