| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,750 |
1,729 |
$802K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,211 |
2,194 |
$139K |
| D3348 |
|
253 |
249 |
$117K |
| D1110 |
Prophylaxis - adult |
995 |
986 |
$83K |
| D3320 |
|
227 |
222 |
$82K |
| D4341 |
|
1,010 |
544 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,257 |
1,251 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
979 |
849 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,182 |
910 |
$63K |
| D4342 |
|
1,500 |
858 |
$61K |
| D2740 |
Crown - porcelain/ceramic |
124 |
110 |
$59K |
| D4910 |
|
453 |
453 |
$33K |
| D3310 |
|
62 |
55 |
$18K |
| D2331 |
|
198 |
160 |
$16K |
| D2330 |
|
202 |
131 |
$15K |
| D5110 |
|
24 |
24 |
$14K |
| D0274 |
Bitewings - four radiographic images |
432 |
431 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
117 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
228 |
178 |
$925.43 |