| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2331 |
|
4,342 |
698 |
$510K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,636 |
1,037 |
$490K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,105 |
840 |
$287K |
| D2750 |
|
278 |
200 |
$137K |
| D3320 |
|
131 |
86 |
$85K |
| D4341 |
|
991 |
365 |
$82K |
| D1110 |
Prophylaxis - adult |
1,180 |
1,173 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,381 |
1,371 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
253 |
155 |
$43K |
| D2740 |
Crown - porcelain/ceramic |
113 |
64 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
621 |
621 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
769 |
757 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
825 |
825 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
582 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
101 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
306 |
286 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,254 |
1,154 |
$14K |
| D3310 |
|
24 |
12 |
$13K |
| D2950 |
|
150 |
90 |
$13K |
| D0274 |
Bitewings - four radiographic images |
493 |
484 |
$12K |
| D1120 |
Prophylaxis - child |
121 |
121 |
$6K |
| D2330 |
|
44 |
24 |
$4K |
| D7250 |
|
22 |
14 |
$2K |
| D4910 |
|
38 |
38 |
$2K |
| D1330 |
|
43 |
43 |
$295.20 |