| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3310 |
|
114 |
42 |
$59K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
91 |
58 |
$50K |
| D3320 |
|
81 |
52 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
449 |
107 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
213 |
123 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
130 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
314 |
280 |
$25K |
| D2394 |
|
151 |
83 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
100 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
316 |
285 |
$15K |
| D2332 |
|
80 |
46 |
$13K |
| D2330 |
|
88 |
35 |
$8K |
| D1110 |
Prophylaxis - adult |
164 |
148 |
$7K |
| D2335 |
|
33 |
14 |
$6K |
| D2331 |
|
49 |
29 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
26 |
$976.18 |
| D1208 |
Topical application of fluoride, excluding varnish |
33 |
29 |
$681.00 |