| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,238 |
496 |
$20K |
| D2740 |
Crown - porcelain/ceramic |
392 |
318 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,113 |
286 |
$16K |
| D3320 |
|
137 |
125 |
$9K |
| D2332 |
|
837 |
363 |
$7K |
| D2950 |
|
544 |
424 |
$5K |
| D1110 |
Prophylaxis - adult |
1,119 |
1,101 |
$3K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
162 |
144 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,274 |
1,731 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
328 |
110 |
$3K |
| D1355 |
|
1,634 |
330 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,083 |
1,067 |
$3K |
| D1354 |
|
1,454 |
292 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,111 |
1,095 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,881 |
1,849 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,107 |
1,091 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
319 |
$1K |
| D2750 |
|
47 |
43 |
$800.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
39 |
$450.00 |
| D9110 |
|
13 |
13 |
$80.00 |