| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
802 |
659 |
$569K |
| D2954 |
|
2,037 |
1,251 |
$378K |
| D3320 |
|
396 |
301 |
$224K |
| D3310 |
|
227 |
96 |
$106K |
| D2740 |
Crown - porcelain/ceramic |
49 |
30 |
$34K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
47 |
29 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
552 |
528 |
$19K |
| D2950 |
|
80 |
51 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
62 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
150 |
77 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
448 |
443 |
$9K |
| D1110 |
Prophylaxis - adult |
134 |
134 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
357 |
349 |
$5K |
| D0274 |
Bitewings - four radiographic images |
127 |
126 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
316 |
236 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$916.00 |
| D9110 |
|
14 |
12 |
$417.00 |