| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
525 |
334 |
$306K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
148 |
128 |
$85K |
| D1110 |
Prophylaxis - adult |
1,468 |
1,400 |
$66K |
| D2950 |
|
369 |
258 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
856 |
799 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,100 |
1,044 |
$38K |
| D2394 |
|
189 |
109 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,109 |
1,762 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
772 |
699 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
94 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
833 |
803 |
$21K |
| D0274 |
Bitewings - four radiographic images |
508 |
490 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
52 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,147 |
944 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
30 |
$6K |
| D4341 |
|
30 |
12 |
$5K |
| D2954 |
|
15 |
12 |
$3K |
| D0270 |
|
98 |
80 |
$968.45 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$690.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$577.15 |
| D2940 |
|
13 |
12 |
$361.92 |