| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,341 |
10,433 |
$2.73M |
| 00003 |
Internal/system code - not a standard HCPCS code |
341 |
225 |
$74K |
| D1110 |
Prophylaxis - adult |
4,274 |
4,191 |
$65K |
| D1206 |
Topical application of fluoride varnish |
5,617 |
5,565 |
$64K |
| D1120 |
Prophylaxis - child |
2,047 |
2,036 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
4,488 |
4,401 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,967 |
4,408 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
6,999 |
6,422 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
2,096 |
2,049 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,681 |
2,631 |
$31K |
| D9999 |
Unspecified adjunctive procedure, by report |
231 |
212 |
$25K |
| D0274 |
Bitewings - four radiographic images |
4,019 |
3,955 |
$21K |
| D9430 |
|
3,147 |
2,873 |
$18K |
| D1351 |
Sealant - per tooth |
694 |
201 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
532 |
426 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
518 |
276 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
458 |
346 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
914 |
871 |
$4K |
| D0270 |
|
1,910 |
1,809 |
$3K |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
17 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
67 |
56 |
$336.00 |
| D0601 |
|
460 |
459 |
$185.00 |
| D0603 |
|
296 |
295 |
$164.00 |
| D0602 |
|
205 |
205 |
$94.00 |
| D2140 |
|
37 |
29 |
$75.00 |