| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,047 |
483 |
$668K |
| D2954 |
|
312 |
160 |
$52K |
| D2950 |
|
219 |
120 |
$32K |
| D1110 |
Prophylaxis - adult |
555 |
523 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
584 |
542 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
27 |
$23K |
| D0274 |
Bitewings - four radiographic images |
683 |
636 |
$22K |
| D3320 |
|
34 |
24 |
$20K |
| D0330 |
Panoramic radiographic image |
582 |
541 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
179 |
173 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
26 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$522.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
12 |
$180.00 |