| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,160 |
7,364 |
$1.45M |
| D1110 |
Prophylaxis - adult |
3,694 |
3,382 |
$15K |
| D1120 |
Prophylaxis - child |
319 |
292 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
1,978 |
1,746 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,380 |
1,190 |
$7K |
| D1206 |
Topical application of fluoride varnish |
171 |
154 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
179 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
1,475 |
1,347 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
299 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,887 |
1,737 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
78 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
654 |
619 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
59 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$935.00 |
| D1351 |
Sealant - per tooth |
52 |
13 |
$826.00 |
| D2140 |
|
16 |
14 |
$225.00 |
| D9992 |
|
50 |
47 |
$66.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
102 |
55 |
$8.00 |
| D0TPC |
|
13 |
13 |
$0.00 |
| D0602 |
|
110 |
110 |
$0.00 |
| D0603 |
|
42 |
41 |
$0.00 |
| D1330 |
|
547 |
547 |
$0.00 |