| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,315 |
701 |
$617K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
425 |
359 |
$195K |
| D3320 |
|
396 |
280 |
$143K |
| D2954 |
|
1,277 |
704 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,763 |
1,754 |
$114K |
| D0210 |
Intraoral - complete series of radiographic images |
1,254 |
1,253 |
$59K |
| D3310 |
|
191 |
93 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
365 |
112 |
$43K |
| D7220 |
|
173 |
62 |
$24K |
| D5130 |
|
12 |
12 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
83 |
$960.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$360.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
26 |
$230.85 |