| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,926 |
6,498 |
$1.50M |
| D0274 |
Bitewings - four radiographic images |
54,880 |
53,342 |
$868K |
| D1110 |
Prophylaxis - adult |
27,731 |
26,966 |
$771K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24,614 |
23,822 |
$696K |
| D0330 |
Panoramic radiographic image |
23,992 |
23,185 |
$582K |
| D0230 |
Intraoral - periapical each additional radiographic image |
61,105 |
42,440 |
$537K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,238 |
2,475 |
$457K |
| D8090 |
|
171 |
164 |
$449K |
| D0220 |
Intraoral - periapical first radiographic image |
68,575 |
64,972 |
$429K |
| D0120 |
Periodic oral evaluation - established patient |
18,280 |
17,713 |
$298K |
| D8660 |
|
1,477 |
1,384 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
13,114 |
12,617 |
$176K |
| D1206 |
Topical application of fluoride varnish |
11,950 |
11,570 |
$153K |
| D0340 |
|
1,987 |
1,870 |
$112K |
| D8670 |
Periodic orthodontic treatment visit |
832 |
798 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
806 |
409 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
5,747 |
5,496 |
$87K |
| D0350 |
|
1,544 |
1,437 |
$47K |
| D1120 |
Prophylaxis - child |
1,915 |
1,857 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
724 |
435 |
$33K |
| D9243 |
|
144 |
135 |
$30K |
| D7240 |
Removal of impacted tooth - completely bony |
106 |
40 |
$28K |
| D4342 |
|
254 |
101 |
$22K |
| D9239 |
|
144 |
135 |
$15K |
| D1351 |
Sealant - per tooth |
368 |
107 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
79 |
$10K |
| D9310 |
|
157 |
157 |
$6K |
| D4346 |
|
69 |
69 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
424 |
415 |
$3K |
| D0272 |
Bitewings - two radiographic images |
124 |
117 |
$2K |
| D2950 |
|
25 |
24 |
$1K |
| D1999 |
|
2,640 |
2,474 |
$1K |
| D0270 |
|
111 |
110 |
$500.78 |
| D1330 |
|
283 |
260 |
$0.00 |
| D0603 |
|
31 |
31 |
$0.00 |
| D0601 |
|
121 |
121 |
$0.00 |