| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,406 |
207 |
$207K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
265 |
102 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
975 |
204 |
$115K |
| D3310 |
|
200 |
42 |
$102K |
| D3320 |
|
111 |
38 |
$62K |
| D2335 |
|
121 |
15 |
$18K |
| D2332 |
|
79 |
13 |
$10K |
| D2330 |
|
100 |
25 |
$7K |
| D4355 |
|
65 |
61 |
$6K |
| D1110 |
Prophylaxis - adult |
74 |
72 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
75 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
61 |
$1K |