| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,111 |
14,239 |
$1.83M |
| D1120 |
Prophylaxis - child |
17,585 |
11,940 |
$462K |
| D1206 |
Topical application of fluoride varnish |
21,834 |
14,673 |
$448K |
| D1351 |
Sealant - per tooth |
16,836 |
3,694 |
$221K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,842 |
1,674 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
9,939 |
7,094 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,777 |
1,682 |
$112K |
| D0330 |
Panoramic radiographic image |
2,698 |
2,204 |
$97K |
| D1110 |
Prophylaxis - adult |
6,383 |
5,128 |
$85K |
| D0274 |
Bitewings - four radiographic images |
5,173 |
3,878 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,443 |
1,838 |
$53K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
429 |
299 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,898 |
1,889 |
$32K |
| D1354 |
|
2,588 |
715 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,970 |
2,370 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
444 |
285 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
671 |
402 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
994 |
788 |
$16K |
| D7111 |
|
367 |
226 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,437 |
1,146 |
$7K |
| D2140 |
|
179 |
136 |
$7K |
| D2940 |
|
299 |
175 |
$6K |
| D9310 |
|
527 |
383 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
184 |
139 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
77 |
$3K |
| D9992 |
|
379 |
224 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$900.00 |
| D4355 |
|
13 |
12 |
$150.00 |
| D0270 |
|
16 |
12 |
$48.00 |
| D1330 |
|
43 |
29 |
$0.00 |