| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
70,220 |
59,691 |
$13.32M |
| D0120 |
Periodic oral evaluation - established patient |
15,142 |
14,309 |
$404K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,912 |
4,658 |
$363K |
| D1206 |
Topical application of fluoride varnish |
16,389 |
15,738 |
$302K |
| D1110 |
Prophylaxis - adult |
5,363 |
5,306 |
$243K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,152 |
6,634 |
$228K |
| D1120 |
Prophylaxis - child |
8,570 |
8,028 |
$190K |
| D0220 |
Intraoral - periapical first radiographic image |
22,110 |
20,203 |
$185K |
| D0140 |
Limited oral evaluation - problem focused |
6,999 |
6,358 |
$168K |
| D4341 |
|
4,507 |
2,877 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,786 |
2,128 |
$134K |
| D0274 |
Bitewings - four radiographic images |
10,437 |
9,798 |
$120K |
| D4910 |
|
1,729 |
1,714 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38,280 |
14,889 |
$76K |
| D0330 |
Panoramic radiographic image |
1,964 |
1,888 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,627 |
3,375 |
$33K |
| D4342 |
|
1,388 |
722 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
509 |
295 |
$22K |
| D0270 |
|
2,740 |
2,407 |
$15K |
| D1351 |
Sealant - per tooth |
560 |
146 |
$10K |
| D1999 |
|
661 |
551 |
$8K |
| D9992 |
|
399 |
373 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
125 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
77 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$840.84 |
| D2331 |
|
15 |
15 |
$758.34 |
| D0190 |
|
78 |
77 |
$673.20 |