| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
44,538 |
37,196 |
$11.09M |
| D0120 |
Periodic oral evaluation - established patient |
10,256 |
9,949 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,820 |
3,119 |
$237K |
| D0210 |
Intraoral - complete series of radiographic images |
3,336 |
3,233 |
$136K |
| D1110 |
Prophylaxis - adult |
3,031 |
2,910 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,584 |
3,452 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,249 |
1,765 |
$118K |
| D4341 |
|
3,506 |
2,223 |
$109K |
| D1206 |
Topical application of fluoride varnish |
5,452 |
5,270 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
3,963 |
3,737 |
$93K |
| D4910 |
|
1,362 |
1,338 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
9,302 |
8,918 |
$78K |
| D1120 |
Prophylaxis - child |
2,029 |
1,969 |
$48K |
| D0274 |
Bitewings - four radiographic images |
3,980 |
3,857 |
$48K |
| D1999 |
|
1,845 |
1,642 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,545 |
5,741 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
147 |
$13K |
| D4342 |
|
656 |
370 |
$12K |
| D0270 |
|
1,107 |
1,076 |
$7K |
| D1354 |
|
922 |
407 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
133 |
76 |
$4K |
| D2331 |
|
45 |
36 |
$3K |
| D9992 |
|
123 |
119 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
113 |
$2K |
| D1351 |
Sealant - per tooth |
73 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
97 |
96 |
$980.28 |
| D0603 |
|
31 |
31 |
$0.00 |
| D1330 |
|
38 |
37 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
19 |
19 |
$0.00 |