| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2331 |
|
5,741 |
582 |
$458K |
| D2332 |
|
3,849 |
431 |
$373K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,627 |
715 |
$277K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,205 |
875 |
$219K |
| D2330 |
|
2,687 |
283 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
4,855 |
4,456 |
$65K |
| D1110 |
Prophylaxis - adult |
1,003 |
948 |
$46K |
| D2140 |
|
799 |
250 |
$36K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
536 |
220 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
177 |
65 |
$12K |
| D2160 |
|
78 |
42 |
$6K |
| D4341 |
|
166 |
39 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
41 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
38 |
$1K |
| D9110 |
|
26 |
26 |
$1K |