| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
57,127 |
45,059 |
$11.64M |
| D1110 |
Prophylaxis - adult |
10,414 |
10,148 |
$20K |
| D1206 |
Topical application of fluoride varnish |
17,590 |
17,001 |
$14K |
| D1120 |
Prophylaxis - child |
7,754 |
7,524 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,936 |
1,389 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,926 |
2,307 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
6,537 |
6,109 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,262 |
1,234 |
$3K |
| D1351 |
Sealant - per tooth |
6,595 |
2,163 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
5,674 |
5,328 |
$1K |
| D0191 |
|
3,631 |
3,522 |
$952.70 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
16 |
$555.90 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
168 |
$454.07 |
| D0120 |
Periodic oral evaluation - established patient |
11,275 |
10,891 |
$285.16 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,661 |
2,504 |
$209.14 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,271 |
511 |
$122.97 |
| D0274 |
Bitewings - four radiographic images |
6,005 |
5,815 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,568 |
1,480 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
39 |
24 |
$0.00 |
| D0270 |
|
13 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
4,539 |
4,386 |
$0.00 |
| D4355 |
|
79 |
79 |
$0.00 |
| D5899 |
|
807 |
433 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
769 |
731 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
90 |
$0.00 |
| D9248 |
|
13 |
13 |
$0.00 |
| D4342 |
|
25 |
13 |
$0.00 |
| D2330 |
|
28 |
16 |
$0.00 |