| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
448 |
190 |
$119K |
| D2740 |
Crown - porcelain/ceramic |
468 |
168 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,294 |
1,129 |
$29K |
| D2950 |
|
543 |
225 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,387 |
1,464 |
$15K |
| D1110 |
Prophylaxis - adult |
549 |
286 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,649 |
653 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
561 |
296 |
$5K |
| D0330 |
Panoramic radiographic image |
272 |
137 |
$5K |
| D0274 |
Bitewings - four radiographic images |
475 |
241 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
169 |
96 |
$1K |
| D1999 |
|
116 |
53 |
$610.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
94 |
50 |
$0.00 |