| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
764 |
622 |
$268K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
391 |
367 |
$147K |
| D2950 |
|
1,312 |
1,119 |
$127K |
| D1110 |
Prophylaxis - adult |
1,656 |
1,617 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,675 |
1,615 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
519 |
253 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,306 |
1,282 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
614 |
599 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
801 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,929 |
2,808 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,329 |
1,300 |
$17K |
| D1206 |
Topical application of fluoride varnish |
618 |
601 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,467 |
1,120 |
$7K |
| D0330 |
Panoramic radiographic image |
643 |
631 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
39 |
$5K |
| D0270 |
|
767 |
748 |
$4K |
| D2332 |
|
45 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
92 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
56 |
56 |
$2K |
| D0272 |
Bitewings - two radiographic images |
153 |
152 |
$1K |