| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,458 |
7,518 |
$1.57M |
| D1206 |
Topical application of fluoride varnish |
2,340 |
1,203 |
$29K |
| D1110 |
Prophylaxis - adult |
2,762 |
2,137 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,439 |
872 |
$16K |
| D1120 |
Prophylaxis - child |
975 |
408 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,972 |
1,077 |
$16K |
| D0274 |
Bitewings - four radiographic images |
2,163 |
1,495 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
3,931 |
2,004 |
$14K |
| D0330 |
Panoramic radiographic image |
757 |
530 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,764 |
1,559 |
$6K |
| D1351 |
Sealant - per tooth |
696 |
102 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
3,787 |
3,026 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
975 |
712 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
2,217 |
1,784 |
$4K |
| D0272 |
Bitewings - two radiographic images |
534 |
208 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
735 |
$2K |
| D1354 |
|
83 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$42.00 |
| D2940 |
|
19 |
18 |
$0.00 |
| D1330 |
|
737 |
702 |
$0.00 |
| D0603 |
|
196 |
188 |
$0.00 |
| D0602 |
|
450 |
428 |
$0.00 |
| D0601 |
|
15 |
13 |
$0.00 |