| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
582 |
231 |
$0.00 |
| D2950 |
|
618 |
254 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
767 |
660 |
$0.00 |
| D4341 |
|
209 |
61 |
$0.00 |
| D0330 |
Panoramic radiographic image |
285 |
285 |
$0.00 |
| D7880 |
|
112 |
112 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
340 |
338 |
$0.00 |
| D1110 |
Prophylaxis - adult |
213 |
212 |
$0.00 |
| D3320 |
|
15 |
12 |
$0.00 |
| D4910 |
|
30 |
30 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
30 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
234 |
234 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
541 |
406 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,037 |
507 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
49 |
41 |
$0.00 |
| D2335 |
|
386 |
64 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
185 |
185 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
687 |
194 |
$0.00 |
| D4355 |
|
28 |
28 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
96 |
41 |
$0.00 |