| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
208 |
147 |
$138K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
217 |
173 |
$135K |
| D1110 |
Prophylaxis - adult |
2,632 |
2,558 |
$130K |
| D0274 |
Bitewings - four radiographic images |
1,543 |
1,502 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,250 |
1,216 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,195 |
1,118 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,816 |
1,777 |
$40K |
| D3320 |
|
52 |
39 |
$25K |
| D2950 |
|
153 |
113 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,682 |
1,552 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
155 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
157 |
152 |
$11K |
| D0330 |
Panoramic radiographic image |
247 |
224 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
103 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
631 |
340 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
50 |
25 |
$4K |
| D1120 |
Prophylaxis - child |
41 |
40 |
$2K |
| D1206 |
Topical application of fluoride varnish |
76 |
76 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
26 |
$696.00 |
| D9110 |
|
13 |
12 |
$456.00 |
| D1999 |
|
849 |
653 |
$0.00 |