| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,017 |
14,181 |
$3.04M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,728 |
1,247 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,537 |
2,417 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,207 |
949 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,788 |
2,559 |
$77K |
| D0330 |
Panoramic radiographic image |
2,476 |
2,333 |
$70K |
| D1110 |
Prophylaxis - adult |
1,270 |
1,185 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
5,284 |
4,855 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
889 |
667 |
$50K |
| D4341 |
|
1,333 |
753 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,949 |
2,798 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,828 |
1,751 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
790 |
780 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,221 |
3,118 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
76 |
$7K |
| D0270 |
|
854 |
767 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
47 |
44 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
71 |
$3K |
| D2331 |
|
31 |
24 |
$3K |
| D1999 |
|
165 |
133 |
$2K |
| D4910 |
|
36 |
36 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$1K |
| D9992 |
|
75 |
74 |
$1K |
| D4342 |
|
49 |
36 |
$1K |
| D4346 |
|
15 |
12 |
$912.00 |