| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
2,439 |
1,528 |
$1.76M |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,606 |
1,375 |
$1.14M |
| D2954 |
|
1,998 |
1,243 |
$359K |
| D3320 |
|
642 |
540 |
$357K |
| D2950 |
|
1,300 |
1,100 |
$213K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
338 |
152 |
$165K |
| D3310 |
|
310 |
181 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
2,454 |
2,381 |
$92K |
| D1110 |
Prophylaxis - adult |
1,220 |
1,188 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,243 |
4,109 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,472 |
1,428 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,996 |
2,278 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
829 |
795 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,207 |
1,183 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
751 |
734 |
$22K |
| D1120 |
Prophylaxis - child |
360 |
351 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0272 |
Bitewings - two radiographic images |
56 |
52 |
$2K |
| D0270 |
|
18 |
14 |
$173.00 |