| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
11,286 |
8,441 |
$4.64M |
| D0120 |
Periodic oral evaluation - established patient |
1,840 |
1,772 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,937 |
1,714 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,418 |
2,286 |
$37K |
| D1351 |
Sealant - per tooth |
2,833 |
581 |
$27K |
| D1120 |
Prophylaxis - child |
951 |
885 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
233 |
$15K |
| D0330 |
Panoramic radiographic image |
397 |
381 |
$12K |
| D1110 |
Prophylaxis - adult |
366 |
346 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
333 |
314 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
150 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
879 |
793 |
$8K |
| D0274 |
Bitewings - four radiographic images |
496 |
480 |
$6K |
| D4910 |
|
131 |
129 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
145 |
118 |
$1K |
| D1354 |
|
483 |
142 |
$1K |
| D0272 |
Bitewings - two radiographic images |
82 |
80 |
$708.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
149 |
51 |
$264.42 |
| D1330 |
|
209 |
198 |
$0.00 |
| D0603 |
|
60 |
58 |
$0.00 |
| D0190 |
|
22 |
16 |
$0.00 |