| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
903 |
461 |
$429K |
| D2954 |
|
844 |
468 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,119 |
1,113 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
906 |
901 |
$43K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
80 |
70 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
478 |
241 |
$32K |
| D4341 |
|
344 |
92 |
$24K |
| D3348 |
|
33 |
27 |
$15K |
| D1110 |
Prophylaxis - adult |
128 |
128 |
$11K |
| D0350 |
|
867 |
217 |
$8K |
| D4910 |
|
100 |
100 |
$8K |
| D3320 |
|
13 |
12 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
585 |
131 |
$2K |
| D4342 |
|
54 |
14 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
30 |
30 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$180.00 |