| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
25,714 |
22,793 |
$5.60M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,633 |
1,994 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
6,061 |
5,929 |
$149K |
| D1206 |
Topical application of fluoride varnish |
8,461 |
8,292 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,621 |
1,836 |
$140K |
| D1120 |
Prophylaxis - child |
5,338 |
5,220 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,454 |
2,398 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
10,044 |
9,767 |
$82K |
| D0274 |
Bitewings - four radiographic images |
5,660 |
5,561 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
2,463 |
2,354 |
$60K |
| D1110 |
Prophylaxis - adult |
1,214 |
1,192 |
$47K |
| D1351 |
Sealant - per tooth |
1,767 |
676 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,779 |
7,717 |
$23K |
| D4341 |
|
777 |
573 |
$22K |
| D0330 |
Panoramic radiographic image |
718 |
695 |
$21K |
| D1999 |
|
798 |
676 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,005 |
970 |
$9K |
| D9992 |
|
286 |
283 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
56 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D0270 |
|
78 |
68 |
$528.48 |
| D2331 |
|
14 |
12 |
$516.64 |
| D9995 |
|
51 |
51 |
$510.00 |