| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
95,944 |
81,572 |
$14.24M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,651 |
4,405 |
$0.00 |
| D1110 |
Prophylaxis - adult |
25,827 |
22,253 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
16,379 |
14,281 |
$0.00 |
| D1120 |
Prophylaxis - child |
5,916 |
5,459 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
10,922 |
9,050 |
$0.00 |
| D2940 |
|
353 |
207 |
$0.00 |
| D0330 |
Panoramic radiographic image |
205 |
180 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
45 |
39 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$0.00 |
| DCAR |
|
71 |
33 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
9,020 |
4,738 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
20,317 |
17,758 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12,371 |
11,322 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,905 |
3,128 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,626 |
6,635 |
$0.00 |
| D0601 |
|
3,116 |
2,670 |
$0.00 |
| D0603 |
|
10,060 |
8,885 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,326 |
768 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
7,022 |
6,169 |
$0.00 |
| D0602 |
|
4,823 |
4,262 |
$0.00 |
| D9992 |
|
1,306 |
980 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
6,751 |
5,824 |
$0.00 |
| D1351 |
Sealant - per tooth |
3,103 |
859 |
$0.00 |
| D9310 |
|
210 |
174 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
161 |
120 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
108 |
84 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
26 |
$0.00 |