| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
3,362 |
373 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,034 |
602 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,149 |
427 |
$153K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
272 |
142 |
$126K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,897 |
463 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
762 |
762 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
690 |
690 |
$32K |
| D2931 |
|
292 |
127 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
134 |
$31K |
| D1110 |
Prophylaxis - adult |
352 |
351 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
374 |
374 |
$28K |
| D4910 |
|
318 |
318 |
$24K |
| D4341 |
|
281 |
79 |
$20K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
34 |
18 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,104 |
1,102 |
$16K |
| D1120 |
Prophylaxis - child |
294 |
293 |
$14K |
| D3320 |
|
33 |
26 |
$12K |
| D2160 |
|
173 |
53 |
$10K |
| D0274 |
Bitewings - four radiographic images |
416 |
416 |
$9K |
| D2932 |
|
61 |
23 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
44 |
21 |
$2K |
| D2954 |
|
21 |
16 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$144.00 |