| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,206 |
4,384 |
$900K |
| D0140 |
Limited oral evaluation - problem focused |
15,976 |
13,653 |
$492K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,880 |
2,049 |
$474K |
| D1110 |
Prophylaxis - adult |
12,301 |
11,210 |
$416K |
| D0120 |
Periodic oral evaluation - established patient |
17,748 |
16,069 |
$414K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,226 |
17,158 |
$413K |
| D0220 |
Intraoral - periapical first radiographic image |
29,227 |
25,522 |
$375K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,105 |
7,901 |
$325K |
| D0330 |
Panoramic radiographic image |
7,212 |
6,474 |
$303K |
| D0274 |
Bitewings - four radiographic images |
10,635 |
9,604 |
$283K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,165 |
1,420 |
$276K |
| D2394 |
|
1,252 |
699 |
$187K |
| D8670 |
Periodic orthodontic treatment visit |
2,239 |
2,072 |
$185K |
| D1206 |
Topical application of fluoride varnish |
12,175 |
11,185 |
$182K |
| D1120 |
Prophylaxis - child |
5,103 |
4,784 |
$130K |
| D0210 |
Intraoral - complete series of radiographic images |
2,636 |
2,184 |
$123K |
| D4355 |
|
1,570 |
1,455 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,771 |
817 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
558 |
367 |
$39K |
| D0272 |
Bitewings - two radiographic images |
2,207 |
2,075 |
$36K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
63 |
55 |
$35K |
| D1351 |
Sealant - per tooth |
929 |
202 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
134 |
61 |
$22K |
| D0270 |
|
2,534 |
1,989 |
$16K |
| D7230 |
|
23 |
15 |
$3K |
| D7250 |
|
40 |
12 |
$3K |
| D7450 |
|
19 |
12 |
$2K |
| D2335 |
|
18 |
14 |
$2K |
| D4341 |
|
23 |
12 |
$2K |
| D0340 |
|
102 |
96 |
$2K |
| D0470 |
|
101 |
96 |
$1K |
| D4346 |
|
26 |
26 |
$1K |