| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
31,431 |
25,667 |
$3.94M |
| D0140 |
Limited oral evaluation - problem focused |
5,798 |
5,350 |
$97.55 |
| D1120 |
Prophylaxis - child |
5,071 |
4,521 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
603 |
570 |
$0.00 |
| D1110 |
Prophylaxis - adult |
4,713 |
4,381 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
147 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
65 |
52 |
$0.00 |
| D0330 |
Panoramic radiographic image |
83 |
81 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
4,593 |
4,217 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,004 |
3,501 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
625 |
526 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
561 |
$0.00 |
| D1351 |
Sealant - per tooth |
648 |
154 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
644 |
574 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
394 |
261 |
$0.00 |
| D0602 |
|
73 |
62 |
$0.00 |
| D0601 |
|
92 |
82 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
24 |
$0.00 |
| D0603 |
|
29 |
24 |
$0.00 |