| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
567 |
269 |
$404K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
158 |
132 |
$114K |
| D2950 |
|
502 |
251 |
$79K |
| D1110 |
Prophylaxis - adult |
512 |
497 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
534 |
515 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
236 |
$17K |
| D3320 |
|
21 |
15 |
$13K |
| D4211 |
|
182 |
128 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
278 |
262 |
$10K |
| D0274 |
Bitewings - four radiographic images |
119 |
111 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
161 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
88 |
86 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
14 |
$907.64 |
| D0460 |
|
29 |
27 |
$0.00 |
| D9450 |
|
66 |
64 |
$0.00 |
| D1330 |
|
81 |
77 |
$0.00 |