| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,122 |
518 |
$694K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
224 |
171 |
$134K |
| D2954 |
|
621 |
326 |
$104K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
158 |
105 |
$71K |
| D1110 |
Prophylaxis - adult |
1,031 |
970 |
$52K |
| D2950 |
|
299 |
158 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
228 |
91 |
$30K |
| D3320 |
|
61 |
41 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
794 |
730 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
482 |
454 |
$19K |
| D0330 |
Panoramic radiographic image |
311 |
290 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,013 |
916 |
$14K |
| D0274 |
Bitewings - four radiographic images |
349 |
338 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
440 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
112 |
108 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
217 |
137 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
13 |
$1K |
| D1206 |
Topical application of fluoride varnish |
38 |
33 |
$196.00 |