| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,114 |
7,804 |
$1.45M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,286 |
764 |
$34K |
| D1120 |
Prophylaxis - child |
784 |
638 |
$24K |
| D1206 |
Topical application of fluoride varnish |
970 |
767 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,080 |
556 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
2,277 |
1,674 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,827 |
1,276 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,624 |
1,066 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
2,583 |
2,102 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
994 |
692 |
$9K |
| D1351 |
Sealant - per tooth |
424 |
92 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,315 |
1,902 |
$4K |
| D1110 |
Prophylaxis - adult |
573 |
538 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
140 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
84 |
75 |
$480.00 |
| D0330 |
Panoramic radiographic image |
44 |
39 |
$450.00 |
| D2331 |
|
64 |
46 |
$210.00 |
| D9992 |
|
173 |
154 |
$140.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
67 |
41 |
$72.00 |
| D2940 |
|
90 |
72 |
$35.00 |