| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
14,862 |
13,794 |
$1.82M |
| D1120 |
Prophylaxis - child |
13,927 |
7,905 |
$333K |
| D1206 |
Topical application of fluoride varnish |
17,617 |
9,771 |
$331K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,589 |
2,092 |
$200K |
| D1351 |
Sealant - per tooth |
8,978 |
1,792 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
10,685 |
5,566 |
$101K |
| D1354 |
|
7,577 |
1,815 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,886 |
1,422 |
$89K |
| D0330 |
Panoramic radiographic image |
2,146 |
1,520 |
$68K |
| D1110 |
Prophylaxis - adult |
4,568 |
3,183 |
$64K |
| D0274 |
Bitewings - four radiographic images |
3,990 |
2,650 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,740 |
1,670 |
$43K |
| D0272 |
Bitewings - two radiographic images |
3,522 |
2,069 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,096 |
523 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
1,726 |
1,072 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,019 |
2,007 |
$13K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
129 |
78 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
223 |
125 |
$7K |
| D7111 |
|
214 |
72 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
50 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,519 |
543 |
$2K |
| D2140 |
|
62 |
42 |
$2K |
| D9310 |
|
253 |
177 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
162 |
86 |
$2K |
| D2940 |
|
176 |
114 |
$2K |
| D9992 |
|
129 |
73 |
$748.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
19 |
$630.00 |
| D9920 |
|
29 |
21 |
$575.00 |
| D0270 |
|
40 |
32 |
$84.00 |
| D9110 |
|
27 |
25 |
$80.00 |
| D0602 |
|
1,956 |
1,843 |
$0.00 |
| D1310 |
|
22 |
22 |
$0.00 |
| D1330 |
|
2,876 |
2,700 |
$0.00 |
| D0603 |
|
712 |
666 |
$0.00 |