| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,840 |
1,646 |
$915K |
| D0140 |
Limited oral evaluation - problem focused |
3,017 |
2,858 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
444 |
405 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
3,086 |
2,899 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
171 |
$13K |
| D2394 |
|
47 |
41 |
$4K |
| D1999 |
|
310 |
268 |
$2K |
| D0460 |
|
93 |
86 |
$373.45 |
| D0230 |
Intraoral - periapical each additional radiographic image |
152 |
101 |
$353.07 |