| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
26,470 |
2,580 |
$559K |
| D1110 |
Prophylaxis - adult |
18,147 |
16,842 |
$510K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,153 |
5,376 |
$456K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,629 |
5,493 |
$417K |
| D1206 |
Topical application of fluoride varnish |
30,173 |
27,872 |
$399K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,644 |
17,030 |
$382K |
| D0274 |
Bitewings - four radiographic images |
20,752 |
19,300 |
$370K |
| D8670 |
Periodic orthodontic treatment visit |
2,764 |
2,379 |
$356K |
| D0220 |
Intraoral - periapical first radiographic image |
36,953 |
33,643 |
$293K |
| D1120 |
Prophylaxis - child |
12,435 |
11,386 |
$278K |
| D0120 |
Periodic oral evaluation - established patient |
16,559 |
15,542 |
$258K |
| D0140 |
Limited oral evaluation - problem focused |
10,560 |
9,630 |
$204K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,417 |
27,907 |
$202K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,112 |
2,176 |
$191K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,958 |
1,184 |
$164K |
| D0330 |
Panoramic radiographic image |
5,628 |
5,035 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,866 |
1,382 |
$134K |
| D0272 |
Bitewings - two radiographic images |
7,808 |
7,190 |
$108K |
| D8660 |
|
776 |
616 |
$70K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
88 |
65 |
$63K |
| D4355 |
|
622 |
604 |
$41K |
| D0470 |
|
630 |
507 |
$38K |
| D0340 |
|
852 |
673 |
$38K |
| D4346 |
|
439 |
416 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
791 |
753 |
$31K |
| D0350 |
|
771 |
606 |
$22K |
| D2335 |
|
233 |
152 |
$18K |
| D2332 |
|
251 |
169 |
$17K |
| D2330 |
|
397 |
165 |
$10K |
| D5110 |
|
32 |
25 |
$10K |
| D2331 |
|
278 |
147 |
$9K |
| D0270 |
|
1,277 |
1,078 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
368 |
340 |
$5K |
| D8680 |
|
16 |
15 |
$5K |
| D2394 |
|
64 |
57 |
$5K |
| D7250 |
|
68 |
12 |
$4K |
| D9110 |
|
145 |
119 |
$3K |
| D2940 |
|
26 |
21 |
$581.44 |
| D1999 |
|
3,514 |
2,946 |
$0.00 |