| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,773 |
7,736 |
$1.39M |
| D1120 |
Prophylaxis - child |
26,187 |
25,831 |
$1.33M |
| D8670 |
Periodic orthodontic treatment visit |
5,327 |
5,142 |
$1.28M |
| D1110 |
Prophylaxis - adult |
18,497 |
18,169 |
$1.22M |
| D0120 |
Periodic oral evaluation - established patient |
41,805 |
41,194 |
$1.19M |
| D1206 |
Topical application of fluoride varnish |
38,365 |
37,818 |
$1.00M |
| D1351 |
Sealant - per tooth |
22,073 |
7,560 |
$893K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,560 |
5,228 |
$727K |
| D0274 |
Bitewings - four radiographic images |
12,790 |
12,570 |
$537K |
| D0272 |
Bitewings - two radiographic images |
10,813 |
10,647 |
$327K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,422 |
2,488 |
$313K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,823 |
1,484 |
$221K |
| D0330 |
Panoramic radiographic image |
1,787 |
1,746 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,495 |
2,442 |
$128K |
| D8680 |
|
1,370 |
1,182 |
$125K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
86 |
81 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
1,690 |
1,642 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
3,445 |
3,270 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
584 |
417 |
$58K |
| D2140 |
|
744 |
527 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
711 |
694 |
$50K |
| D8660 |
|
1,658 |
1,628 |
$45K |
| D9110 |
|
647 |
601 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,910 |
1,063 |
$28K |
| D2332 |
|
208 |
136 |
$27K |
| D2330 |
|
225 |
116 |
$21K |
| D2160 |
|
189 |
162 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
382 |
375 |
$11K |
| D7111 |
|
135 |
103 |
$10K |
| D8690 |
|
214 |
198 |
$7K |
| D0180 |
|
60 |
60 |
$2K |
| D2335 |
|
13 |
12 |
$2K |
| D8090 |
|
13 |
13 |
$0.00 |