| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
10,766 |
3,070 |
$1.63M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,668 |
3,005 |
$1.22M |
| D2335 |
|
2,180 |
903 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
6,510 |
6,283 |
$163K |
| D1110 |
Prophylaxis - adult |
4,351 |
4,157 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,014 |
514 |
$153K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,494 |
684 |
$151K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,078 |
5,763 |
$141K |
| D0330 |
Panoramic radiographic image |
2,778 |
2,572 |
$133K |
| D0274 |
Bitewings - four radiographic images |
4,073 |
3,834 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,805 |
2,579 |
$112K |
| D2332 |
|
1,191 |
640 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
7,421 |
6,890 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,123 |
361 |
$105K |
| D4355 |
|
1,445 |
1,382 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
2,432 |
2,273 |
$84K |
| D1120 |
Prophylaxis - child |
2,898 |
2,798 |
$77K |
| D1206 |
Topical application of fluoride varnish |
3,684 |
3,528 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,883 |
1,808 |
$33K |
| D8670 |
Periodic orthodontic treatment visit |
270 |
261 |
$26K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
14 |
12 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
38 |
$4K |
| D1351 |
Sealant - per tooth |
160 |
25 |
$3K |
| D0340 |
|
51 |
46 |
$2K |
| D0470 |
|
50 |
45 |
$2K |
| D1999 |
|
157 |
140 |
$0.00 |