| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
11,795 |
9,122 |
$1.59M |
| D1206 |
Topical application of fluoride varnish |
5,450 |
3,013 |
$101K |
| D1120 |
Prophylaxis - child |
3,865 |
2,279 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,531 |
844 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,452 |
1,265 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
6,681 |
3,496 |
$40K |
| D0274 |
Bitewings - four radiographic images |
2,755 |
2,053 |
$28K |
| D0330 |
Panoramic radiographic image |
542 |
534 |
$26K |
| D1110 |
Prophylaxis - adult |
3,838 |
2,835 |
$24K |
| D1351 |
Sealant - per tooth |
1,723 |
391 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,658 |
1,070 |
$17K |
| D1354 |
|
776 |
179 |
$13K |
| D0272 |
Bitewings - two radiographic images |
683 |
683 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,441 |
905 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,110 |
1,413 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
829 |
616 |
$2K |
| D2940 |
|
360 |
268 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
363 |
162 |
$2K |
| D2140 |
|
531 |
231 |
$2K |
| D7111 |
|
52 |
28 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
110 |
74 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
54 |
$216.00 |
| D2330 |
|
29 |
16 |
$100.00 |
| D1330 |
|
1,679 |
1,588 |
$0.00 |
| D0603 |
|
505 |
467 |
$0.00 |
| D1310 |
|
102 |
95 |
$0.00 |
| D0602 |
|
1,115 |
1,055 |
$0.00 |
| D0601 |
|
26 |
26 |
$0.00 |
| D9992 |
|
82 |
40 |
$0.00 |