| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,071 |
4,134 |
$2.05M |
| D0120 |
Periodic oral evaluation - established patient |
654 |
629 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
461 |
397 |
$12K |
| D1206 |
Topical application of fluoride varnish |
922 |
874 |
$11K |
| D1120 |
Prophylaxis - child |
559 |
534 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,119 |
1,001 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
288 |
278 |
$9K |
| D1110 |
Prophylaxis - adult |
244 |
227 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
44 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
105 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,173 |
292 |
$3K |
| D0274 |
Bitewings - four radiographic images |
110 |
107 |
$1K |
| D0270 |
|
79 |
68 |
$596.88 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$484.51 |
| D0460 |
|
16 |
12 |
$4.85 |
| D1330 |
|
368 |
319 |
$0.00 |
| D1310 |
|
280 |
222 |
$0.00 |
| D9215 |
|
49 |
36 |
$0.00 |
| D0431 |
|
119 |
101 |
$0.00 |