| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
42,654 |
35,834 |
$10.15M |
| D0120 |
Periodic oral evaluation - established patient |
10,209 |
9,711 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,873 |
2,301 |
$171K |
| D1110 |
Prophylaxis - adult |
4,020 |
3,868 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,404 |
3,260 |
$109K |
| D4341 |
|
2,679 |
1,359 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
2,145 |
2,077 |
$92K |
| D1206 |
Topical application of fluoride varnish |
4,784 |
4,657 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
9,361 |
8,851 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,593 |
1,249 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,883 |
2,654 |
$64K |
| D0274 |
Bitewings - four radiographic images |
5,062 |
4,850 |
$56K |
| D4910 |
|
885 |
872 |
$47K |
| D1120 |
Prophylaxis - child |
1,625 |
1,563 |
$38K |
| D1999 |
|
1,855 |
1,528 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,871 |
6,339 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
161 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
28 |
$3K |
| D0270 |
|
386 |
368 |
$2K |
| D4342 |
|
144 |
81 |
$2K |
| D9992 |
|
161 |
151 |
$2K |
| D2330 |
|
29 |
12 |
$1K |
| D2331 |
|
17 |
13 |
$855.02 |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
55 |
$635.76 |
| D1354 |
|
172 |
77 |
$495.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$0.00 |