| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
497 |
386 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,507 |
729 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,287 |
1,284 |
$85K |
| D1110 |
Prophylaxis - adult |
779 |
777 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,057 |
1,055 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,194 |
1,190 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
593 |
392 |
$46K |
| D2952 |
|
395 |
309 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
377 |
$38K |
| D0350 |
|
3,622 |
1,489 |
$37K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
59 |
51 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,814 |
1,801 |
$26K |
| D1120 |
Prophylaxis - child |
544 |
542 |
$20K |
| D0274 |
Bitewings - four radiographic images |
698 |
697 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,688 |
1,259 |
$11K |
| D9430 |
|
312 |
298 |
$10K |
| D2394 |
|
69 |
49 |
$6K |
| D2330 |
|
78 |
41 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
197 |
192 |
$2K |
| D1999 |
|
17 |
16 |
$0.00 |