| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
128,659 |
115,315 |
$14.80M |
| D0120 |
Periodic oral evaluation - established patient |
45,654 |
45,013 |
$1.23M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,084 |
9,837 |
$846K |
| D1206 |
Topical application of fluoride varnish |
39,826 |
39,289 |
$658K |
| D1110 |
Prophylaxis - adult |
15,681 |
15,456 |
$614K |
| D0330 |
Panoramic radiographic image |
13,080 |
12,763 |
$464K |
| D0272 |
Bitewings - two radiographic images |
45,853 |
45,062 |
$444K |
| D1120 |
Prophylaxis - child |
16,590 |
16,370 |
$390K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,848 |
5,614 |
$388K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,421 |
8,182 |
$307K |
| D0140 |
Limited oral evaluation - problem focused |
11,318 |
10,998 |
$284K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,331 |
3,271 |
$244K |
| D0220 |
Intraoral - periapical first radiographic image |
24,125 |
23,390 |
$221K |
| D4341 |
|
5,000 |
3,777 |
$181K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,167 |
979 |
$95K |
| D1999 |
|
6,732 |
5,877 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,654 |
15,249 |
$59K |
| D0190 |
|
5,175 |
5,151 |
$55K |
| D4910 |
|
1,162 |
1,146 |
$53K |
| D1330 |
|
4,203 |
4,183 |
$50K |
| D1351 |
Sealant - per tooth |
1,060 |
454 |
$22K |
| D2331 |
|
240 |
182 |
$18K |
| D9992 |
|
393 |
383 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
149 |
144 |
$5K |
| D2330 |
|
71 |
56 |
$4K |
| D1354 |
|
1,206 |
473 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
204 |
178 |
$4K |
| D4342 |
|
174 |
109 |
$2K |
| D0274 |
Bitewings - four radiographic images |
69 |
67 |
$693.12 |
| D0270 |
|
13 |
12 |
$73.44 |
| D2940 |
|
62 |
49 |
$0.00 |
| D0602 |
|
5,199 |
5,146 |
$0.00 |
| D0603 |
|
4,783 |
4,735 |
$0.00 |
| D0601 |
|
7,724 |
7,631 |
$0.00 |