| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
870 |
597 |
$603K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
581 |
455 |
$407K |
| D2950 |
|
803 |
559 |
$128K |
| D1110 |
Prophylaxis - adult |
1,714 |
1,660 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
1,615 |
1,563 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
862 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,183 |
1,148 |
$31K |
| D0274 |
Bitewings - four radiographic images |
834 |
809 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
627 |
589 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
285 |
282 |
$20K |
| D1120 |
Prophylaxis - child |
311 |
307 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
725 |
686 |
$11K |
| D0330 |
Panoramic radiographic image |
196 |
190 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
29 |
$812.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
14 |
$264.00 |