| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
43,082 |
37,676 |
$8.67M |
| D0120 |
Periodic oral evaluation - established patient |
11,962 |
11,848 |
$314K |
| D1206 |
Topical application of fluoride varnish |
10,836 |
10,717 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,885 |
2,418 |
$182K |
| D1120 |
Prophylaxis - child |
6,182 |
6,126 |
$144K |
| D1110 |
Prophylaxis - adult |
3,238 |
3,205 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
11,628 |
11,278 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,570 |
1,274 |
$76K |
| D4341 |
|
2,427 |
1,438 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,014 |
1,994 |
$70K |
| D0274 |
Bitewings - four radiographic images |
5,213 |
5,170 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,838 |
2,759 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
787 |
541 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,047 |
8,046 |
$33K |
| D0272 |
Bitewings - two radiographic images |
3,073 |
3,040 |
$30K |
| D0330 |
Panoramic radiographic image |
880 |
870 |
$24K |
| D4910 |
|
405 |
396 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
239 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
262 |
261 |
$4K |
| D0270 |
|
630 |
609 |
$3K |
| D1999 |
|
220 |
186 |
$3K |
| D0190 |
|
266 |
265 |
$3K |
| D1351 |
Sealant - per tooth |
109 |
40 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
40 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$810.24 |
| D0240 |
|
35 |
18 |
$311.85 |
| D0603 |
|
140 |
139 |
$0.00 |
| D0602 |
|
34 |
34 |
$0.00 |