| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
328 |
272 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,722 |
1,720 |
$114K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
245 |
231 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,434 |
1,432 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
376 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
59 |
$12K |
| D3320 |
|
31 |
27 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,481 |
397 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
59 |
$4K |
| D0274 |
Bitewings - four radiographic images |
119 |
119 |
$2K |
| D1206 |
Topical application of fluoride varnish |
152 |
152 |
$2K |
| D1120 |
Prophylaxis - child |
38 |
38 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$2K |