| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
46,691 |
40,787 |
$5.29M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,857 |
7,137 |
$663K |
| D0120 |
Periodic oral evaluation - established patient |
21,254 |
21,057 |
$571K |
| D1206 |
Topical application of fluoride varnish |
24,116 |
23,852 |
$452K |
| D1120 |
Prophylaxis - child |
16,923 |
16,767 |
$412K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,489 |
4,106 |
$293K |
| D1110 |
Prophylaxis - adult |
7,245 |
7,162 |
$292K |
| D1351 |
Sealant - per tooth |
11,626 |
4,032 |
$261K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,462 |
2,102 |
$195K |
| D0272 |
Bitewings - two radiographic images |
18,491 |
18,295 |
$184K |
| D0330 |
Panoramic radiographic image |
5,409 |
5,340 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,860 |
4,800 |
$173K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,294 |
3,818 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
9,706 |
9,530 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,502 |
2,452 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,545 |
3,503 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
521 |
352 |
$29K |
| D2394 |
|
240 |
203 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,170 |
6,614 |
$21K |
| D2331 |
|
129 |
105 |
$12K |
| D4341 |
|
111 |
76 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$2K |
| D2335 |
|
19 |
13 |
$2K |
| D9992 |
|
58 |
58 |
$870.00 |
| D0270 |
|
38 |
38 |
$262.32 |
| D1354 |
|
42 |
13 |
$168.00 |
| D0603 |
|
4,045 |
4,016 |
$0.00 |
| D0602 |
|
82 |
81 |
$0.00 |