| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
239 |
175 |
$116K |
| D2950 |
|
278 |
177 |
$21K |
| D1110 |
Prophylaxis - adult |
556 |
503 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
37 |
28 |
$16K |
| D1999 |
|
883 |
757 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
476 |
392 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
407 |
394 |
$7K |
| D0274 |
Bitewings - four radiographic images |
252 |
227 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
387 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
189 |
178 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$328.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
59 |
37 |
$0.00 |