| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,263 |
8,241 |
$1.92M |
| D1110 |
Prophylaxis - adult |
2,231 |
2,196 |
$132.75 |
| D0120 |
Periodic oral evaluation - established patient |
2,342 |
2,317 |
$67.83 |
| D1206 |
Topical application of fluoride varnish |
1,604 |
1,597 |
$39.14 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,092 |
1,090 |
$33.54 |
| D1120 |
Prophylaxis - child |
979 |
979 |
$33.46 |
| D0220 |
Intraoral - periapical first radiographic image |
1,391 |
1,365 |
$13.10 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,005 |
618 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
203 |
199 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
64 |
$0.00 |
| D1330 |
|
824 |
818 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
610 |
608 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
454 |
447 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
99 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
582 |
455 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
93 |
93 |
$0.00 |
| D1351 |
Sealant - per tooth |
46 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
355 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
773 |
759 |
$0.00 |