| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,899 |
8,756 |
$2.03M |
| D0120 |
Periodic oral evaluation - established patient |
1,365 |
1,354 |
$28K |
| D4341 |
|
1,094 |
624 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,345 |
1,317 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
507 |
403 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
878 |
867 |
$23K |
| D1110 |
Prophylaxis - adult |
538 |
536 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,467 |
2,401 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,039 |
1,033 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,371 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
257 |
172 |
$8K |
| D0330 |
Panoramic radiographic image |
337 |
333 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
270 |
267 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
95 |
$5K |
| D4910 |
|
114 |
114 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,145 |
1,184 |
$4K |
| D0270 |
|
520 |
514 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$905.08 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$298.74 |
| D4342 |
|
22 |
13 |
$276.54 |
| D1208 |
Topical application of fluoride, excluding varnish |
18 |
18 |
$225.25 |
| D0190 |
|
18 |
18 |
$173.40 |
| D1999 |
|
13 |
13 |
$165.00 |
| D0460 |
|
15 |
15 |
$9.70 |