| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D6740 |
|
379 |
132 |
$500K |
| D0330 |
Panoramic radiographic image |
3,941 |
3,907 |
$353K |
| D1110 |
Prophylaxis - adult |
5,295 |
5,253 |
$318K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,507 |
9,583 |
$300K |
| D6245 |
|
227 |
132 |
$298K |
| D1351 |
Sealant - per tooth |
6,929 |
1,597 |
$293K |
| D1206 |
Topical application of fluoride varnish |
8,370 |
8,302 |
$267K |
| D0274 |
Bitewings - four radiographic images |
6,309 |
6,256 |
$259K |
| D2721 |
|
231 |
141 |
$247K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,161 |
1,454 |
$232K |
| D0220 |
Intraoral - periapical first radiographic image |
10,578 |
10,276 |
$185K |
| D0140 |
Limited oral evaluation - problem focused |
4,258 |
4,104 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
5,253 |
5,204 |
$173K |
| D5226 |
|
110 |
109 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,799 |
2,789 |
$148K |
| D2140 |
|
1,853 |
872 |
$142K |
| D1330 |
|
7,491 |
7,368 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,253 |
711 |
$121K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,139 |
691 |
$108K |
| D1120 |
Prophylaxis - child |
2,344 |
2,339 |
$104K |
| D5214 |
|
84 |
84 |
$85K |
| D5225 |
|
44 |
44 |
$64K |
| D0272 |
Bitewings - two radiographic images |
1,468 |
1,466 |
$60K |
| D4355 |
|
778 |
769 |
$50K |
| D0340 |
|
423 |
421 |
$46K |
| D5213 |
|
42 |
42 |
$42K |
| D4341 |
|
161 |
63 |
$35K |
| D0350 |
|
422 |
420 |
$34K |
| D0470 |
|
433 |
432 |
$31K |
| D2950 |
|
132 |
94 |
$26K |
| D2161 |
|
154 |
121 |
$21K |
| D2330 |
|
246 |
150 |
$21K |
| D8660 |
|
431 |
430 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
78 |
$14K |
| D2335 |
|
71 |
38 |
$11K |
| D2331 |
|
77 |
51 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
38 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
27 |
$5K |
| D1310 |
|
145 |
145 |
$4K |
| D2160 |
|
33 |
29 |
$4K |
| D2394 |
|
15 |
13 |
$2K |
| D9985 |
|
129 |
96 |
$0.00 |