| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
522 |
498 |
$285K |
| D2931 |
|
617 |
577 |
$159K |
| D2950 |
|
736 |
671 |
$106K |
| D0330 |
Panoramic radiographic image |
1,058 |
1,039 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,442 |
1,353 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
536 |
321 |
$57K |
| D1110 |
Prophylaxis - adult |
561 |
546 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
221 |
148 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
560 |
553 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
830 |
814 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
495 |
488 |
$11K |
| D1120 |
Prophylaxis - child |
221 |
221 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
186 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
43 |
$5K |
| D0272 |
Bitewings - two radiographic images |
85 |
85 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
55 |
$546.65 |