| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
24,269 |
21,679 |
$3.51M |
| D1206 |
Topical application of fluoride varnish |
19,768 |
12,709 |
$414K |
| D1120 |
Prophylaxis - child |
15,734 |
10,597 |
$383K |
| D1351 |
Sealant - per tooth |
14,246 |
2,781 |
$161K |
| D1110 |
Prophylaxis - adult |
13,145 |
11,325 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
2,200 |
1,766 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
716 |
420 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,694 |
1,346 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
2,939 |
2,549 |
$7K |
| D2140 |
|
420 |
217 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
379 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
488 |
432 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,465 |
1,920 |
$2K |
| D9992 |
|
497 |
457 |
$560.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
268 |
$405.00 |
| D4341 |
|
48 |
27 |
$200.00 |
| D2160 |
|
14 |
12 |
$0.00 |