| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
25,617 |
23,108 |
$8.98M |
| D9430 |
|
30 |
29 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
4,390 |
4,241 |
$180.00 |
| D1110 |
Prophylaxis - adult |
4,089 |
4,010 |
$72.00 |
| D1206 |
Topical application of fluoride varnish |
6,637 |
6,506 |
$18.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,157 |
2,923 |
$8.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
857 |
494 |
$0.00 |
| D0603 |
|
2,128 |
2,020 |
$0.00 |
| D1351 |
Sealant - per tooth |
3,310 |
690 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,913 |
1,202 |
$0.00 |
| D0602 |
|
315 |
313 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
509 |
465 |
$0.00 |
| D1330 |
|
3,895 |
3,883 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
268 |
260 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,401 |
1,368 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
860 |
847 |
$0.00 |
| D2335 |
|
137 |
114 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,509 |
1,237 |
$0.00 |
| D2330 |
|
110 |
94 |
$0.00 |
| D5899 |
|
314 |
244 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
898 |
804 |
$0.00 |
| D2331 |
|
180 |
153 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |
| D4346 |
|
42 |
40 |
$0.00 |
| D0190 |
|
1,354 |
1,347 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,661 |
2,638 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
209 |
198 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,287 |
1,244 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,765 |
2,657 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,395 |
1,107 |
$0.00 |
| D9110 |
|
1,440 |
1,382 |
$0.00 |
| D2332 |
|
169 |
152 |
$0.00 |
| D4341 |
|
22 |
13 |
$0.00 |
| D4910 |
|
61 |
61 |
$0.00 |
| D0270 |
|
29 |
27 |
$0.00 |
| D1354 |
|
28 |
28 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
12 |
12 |
$0.00 |