| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
322 |
179 |
$153K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
110 |
96 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
518 |
$34K |
| D2954 |
|
215 |
148 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
429 |
428 |
$20K |
| D0350 |
|
2,045 |
522 |
$19K |
| D1110 |
Prophylaxis - adult |
165 |
164 |
$14K |
| D3320 |
|
32 |
25 |
$11K |
| D4341 |
|
117 |
31 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
57 |
$6K |
| D1120 |
Prophylaxis - child |
126 |
126 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
16 |
$4K |
| D1351 |
Sealant - per tooth |
66 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
168 |
168 |
$2K |
| D1206 |
Topical application of fluoride varnish |
134 |
132 |
$2K |
| D9430 |
|
47 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
308 |
76 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |