| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
45,855 |
42,167 |
$8.33M |
| D0120 |
Periodic oral evaluation - established patient |
17,888 |
17,795 |
$459K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,193 |
4,880 |
$412K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,598 |
5,336 |
$399K |
| D1120 |
Prophylaxis - child |
11,146 |
11,086 |
$265K |
| D1206 |
Topical application of fluoride varnish |
13,832 |
13,713 |
$252K |
| D0330 |
Panoramic radiographic image |
4,035 |
4,000 |
$153K |
| D1110 |
Prophylaxis - adult |
3,339 |
3,319 |
$131K |
| D0140 |
Limited oral evaluation - problem focused |
3,529 |
3,446 |
$80K |
| D0272 |
Bitewings - two radiographic images |
6,975 |
6,938 |
$71K |
| D0274 |
Bitewings - four radiographic images |
4,763 |
4,729 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,581 |
2,398 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,716 |
3,705 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
908 |
903 |
$36K |
| D1351 |
Sealant - per tooth |
1,484 |
796 |
$32K |
| D0190 |
|
2,034 |
1,991 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
428 |
270 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,707 |
1,679 |
$15K |
| D4341 |
|
304 |
181 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
133 |
$11K |
| D4910 |
|
14 |
14 |
$1K |
| D1354 |
|
347 |
138 |
$1K |
| D2330 |
|
18 |
12 |
$848.98 |
| D0240 |
|
45 |
43 |
$686.07 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
97 |
$273.48 |
| D1330 |
|
99 |
99 |
$12.97 |
| D9999 |
Unspecified adjunctive procedure, by report |
131 |
126 |
$0.00 |
| D0603 |
|
510 |
510 |
$0.00 |