| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,513 |
1,411 |
$593K |
| D0140 |
Limited oral evaluation - problem focused |
2,873 |
2,806 |
$70K |
| D3320 |
|
204 |
185 |
$65K |
| D0364 |
|
557 |
542 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
497 |
445 |
$35K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
442 |
401 |
$24K |
| D0460 |
|
2,329 |
2,224 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,162 |
2,075 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
65 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
128 |
122 |
$2K |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$950.63 |
| D2160 |
|
14 |
12 |
$848.09 |
| D1206 |
Topical application of fluoride varnish |
16 |
13 |
$152.78 |