| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2751 |
Crown - porcelain fused to predominantly base metal |
83 |
44 |
$39K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
27 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
160 |
$10K |
| D2330 |
|
96 |
15 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
134 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
13 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
15 |
$3K |
| D2394 |
|
39 |
14 |
$3K |