| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
586 |
218 |
$429K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,516 |
350 |
$373K |
| D3310 |
|
375 |
67 |
$205K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,727 |
343 |
$205K |
| D3320 |
|
205 |
86 |
$131K |
| D2332 |
|
634 |
80 |
$79K |
| D2330 |
|
216 |
39 |
$18K |
| D4355 |
|
172 |
167 |
$17K |
| D2335 |
|
89 |
12 |
$13K |
| D1110 |
Prophylaxis - adult |
164 |
157 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
177 |
172 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
188 |
$4K |