| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
33,537 |
29,365 |
$7.01M |
| D0120 |
Periodic oral evaluation - established patient |
7,051 |
6,955 |
$187K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,451 |
2,018 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,433 |
1,868 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
6,270 |
6,051 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,840 |
2,156 |
$156K |
| D0330 |
Panoramic radiographic image |
3,614 |
3,552 |
$125K |
| D1120 |
Prophylaxis - child |
5,012 |
4,957 |
$118K |
| D1206 |
Topical application of fluoride varnish |
5,673 |
5,609 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,910 |
1,892 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
9,233 |
7,818 |
$74K |
| D1110 |
Prophylaxis - adult |
1,413 |
1,400 |
$57K |
| D0274 |
Bitewings - four radiographic images |
4,013 |
3,968 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,401 |
1,400 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,242 |
3,190 |
$21K |
| D0272 |
Bitewings - two radiographic images |
2,109 |
2,086 |
$21K |
| D1351 |
Sealant - per tooth |
744 |
215 |
$15K |
| D1330 |
|
1,064 |
1,063 |
$13K |
| D0190 |
|
1,263 |
1,259 |
$13K |
| D0270 |
|
1,664 |
1,623 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
234 |
230 |
$9K |
| D4341 |
|
144 |
94 |
$6K |
| D8660 |
|
19 |
19 |
$6K |
| D0160 |
|
109 |
109 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
17 |
13 |
$4K |
| D2330 |
|
79 |
57 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
39 |
$3K |
| D2331 |
|
39 |
27 |
$2K |
| D9992 |
|
47 |
47 |
$690.00 |
| D9995 |
|
28 |
28 |
$370.00 |
| D4342 |
|
20 |
13 |
$251.40 |
| D0460 |
|
332 |
320 |
$189.15 |