| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
303 |
267 |
$227K |
| D2740 |
Crown - porcelain/ceramic |
404 |
218 |
$159K |
| D2750 |
|
254 |
187 |
$121K |
| D1110 |
Prophylaxis - adult |
1,796 |
1,791 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,825 |
1,821 |
$103K |
| D0330 |
Panoramic radiographic image |
2,046 |
2,043 |
$94K |
| D2950 |
|
1,000 |
572 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
546 |
223 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,064 |
1,056 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,915 |
1,911 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
354 |
199 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,757 |
1,753 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,472 |
2,367 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,060 |
1,048 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
568 |
567 |
$18K |
| D3120 |
|
475 |
201 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
48 |
$14K |
| D3320 |
|
17 |
14 |
$11K |
| D7220 |
|
50 |
31 |
$8K |
| D4355 |
|
25 |
25 |
$2K |
| D0270 |
|
28 |
28 |
$252.00 |