| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
31,835 |
27,366 |
$6.66M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,055 |
2,876 |
$253K |
| D1206 |
Topical application of fluoride varnish |
7,438 |
7,320 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,333 |
3,279 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,440 |
1,620 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,080 |
4,022 |
$108K |
| D0330 |
Panoramic radiographic image |
3,024 |
2,973 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
10,506 |
10,214 |
$91K |
| D1120 |
Prophylaxis - child |
3,327 |
3,262 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,918 |
2,826 |
$70K |
| D4341 |
|
2,040 |
1,336 |
$70K |
| D0274 |
Bitewings - four radiographic images |
4,047 |
3,983 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
807 |
466 |
$39K |
| D1110 |
Prophylaxis - adult |
827 |
818 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,593 |
8,131 |
$35K |
| D1351 |
Sealant - per tooth |
1,791 |
683 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
322 |
264 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,560 |
1,530 |
$15K |
| D1999 |
|
1,045 |
953 |
$13K |
| D9992 |
|
744 |
726 |
$11K |
| D2331 |
|
51 |
39 |
$4K |
| D0270 |
|
688 |
663 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
58 |
$1K |
| D4342 |
|
21 |
12 |
$427.21 |
| D9995 |
|
15 |
15 |
$150.00 |