| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
894 |
522 |
$424K |
| D2954 |
|
734 |
439 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
626 |
$41K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
59 |
54 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
576 |
$27K |
| D0350 |
|
1,092 |
283 |
$9K |
| D3348 |
|
17 |
12 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
44 |
$7K |
| D9430 |
|
218 |
203 |
$7K |
| D4341 |
|
93 |
25 |
$7K |
| D1110 |
Prophylaxis - adult |
65 |
65 |
$5K |
| D1320 |
|
268 |
268 |
$4K |
| D4910 |
|
40 |
40 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
667 |
163 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
181 |
181 |
$3K |
| D0274 |
Bitewings - four radiographic images |
79 |
79 |
$2K |
| D1310 |
|
19 |
19 |
$0.00 |