| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,001 |
11,080 |
$2.47M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
110 |
$65.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,442 |
2,436 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,021 |
820 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,197 |
1,195 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,697 |
2,692 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
442 |
319 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,984 |
2,977 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,519 |
265 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
941 |
939 |
$0.00 |
| D1330 |
|
1,551 |
1,548 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
80 |
80 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| D2331 |
|
32 |
24 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
3,187 |
3,178 |
$0.00 |
| D0191 |
|
414 |
414 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,261 |
1,258 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,695 |
1,694 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,446 |
1,414 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
841 |
676 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$0.00 |