| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,517 |
7,855 |
$1.56M |
| D1110 |
Prophylaxis - adult |
1,928 |
1,870 |
$9K |
| D1120 |
Prophylaxis - child |
1,969 |
1,949 |
$4K |
| D1206 |
Topical application of fluoride varnish |
3,404 |
3,357 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
1,436 |
1,348 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
461 |
198 |
$1K |
| D0274 |
Bitewings - four radiographic images |
806 |
785 |
$720.00 |
| D0220 |
Intraoral - periapical first radiographic image |
690 |
649 |
$477.75 |
| D0120 |
Periodic oral evaluation - established patient |
1,669 |
1,633 |
$397.55 |
| D0330 |
Panoramic radiographic image |
437 |
430 |
$314.35 |
| D0703 |
|
102 |
100 |
$237.17 |
| D0272 |
Bitewings - two radiographic images |
644 |
635 |
$207.26 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
335 |
263 |
$0.00 |
| D9996 |
|
107 |
106 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
231 |
169 |
$0.00 |
| D0603 |
|
108 |
107 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,011 |
278 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
153 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
29 |
$0.00 |
| D1352 |
|
70 |
52 |
$0.00 |
| D2331 |
|
14 |
12 |
$0.00 |