| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,714 |
10,052 |
$1.59M |
| D1120 |
Prophylaxis - child |
3,944 |
2,365 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,239 |
2,052 |
$56K |
| D1351 |
Sealant - per tooth |
3,031 |
513 |
$34K |
| D0274 |
Bitewings - four radiographic images |
3,305 |
2,308 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
4,026 |
2,875 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,247 |
621 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
317 |
$21K |
| D1110 |
Prophylaxis - adult |
3,623 |
2,948 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
818 |
538 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,423 |
1,120 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,309 |
1,829 |
$3K |
| D2940 |
|
226 |
127 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
47 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
105 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
587 |
347 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
247 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
173 |
141 |
$240.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
193 |
108 |
$192.00 |
| DS001 |
|
495 |
393 |
$0.00 |
| D0603 |
|
423 |
383 |
$0.00 |
| D0601 |
|
272 |
223 |
$0.00 |
| D0602 |
|
1,239 |
1,117 |
$0.00 |
| D0024 |
|
561 |
465 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
70 |
47 |
$0.00 |
| D2331 |
|
14 |
12 |
$0.00 |