| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
129 |
72 |
$104K |
| D2332 |
|
607 |
158 |
$88K |
| D1354 |
|
3,406 |
830 |
$81K |
| D1110 |
Prophylaxis - adult |
842 |
808 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
146 |
$29K |
| D0274 |
Bitewings - four radiographic images |
831 |
798 |
$26K |
| D2335 |
|
136 |
44 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
831 |
802 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
162 |
88 |
$20K |
| D2950 |
|
128 |
72 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,256 |
1,017 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
79 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
290 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,343 |
1,238 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$11K |
| D1120 |
Prophylaxis - child |
221 |
212 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
113 |
$5K |
| D2394 |
|
14 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
111 |
108 |
$2K |
| D1320 |
|
32 |
30 |
$943.36 |