| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
493 |
241 |
$234K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
289 |
206 |
$183K |
| D3320 |
|
92 |
56 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
343 |
132 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
578 |
538 |
$16K |
| D0330 |
Panoramic radiographic image |
600 |
552 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
166 |
70 |
$13K |
| D2950 |
|
124 |
72 |
$13K |
| D1110 |
Prophylaxis - adult |
303 |
293 |
$12K |
| D0274 |
Bitewings - four radiographic images |
538 |
505 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
29 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
26 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
83 |
$2K |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$635.50 |
| D0220 |
Intraoral - periapical first radiographic image |
15 |
14 |
$140.91 |