| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
138 |
86 |
$113K |
| D0330 |
Panoramic radiographic image |
587 |
571 |
$41K |
| D2950 |
|
247 |
157 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
799 |
766 |
$31K |
| D0350 |
|
452 |
449 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
267 |
252 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
95 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
626 |
532 |
$5K |
| D1110 |
Prophylaxis - adult |
82 |
79 |
$4K |
| D1320 |
|
140 |
140 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
16 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
171 |
$2K |
| D1354 |
|
72 |
31 |
$2K |