| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
19,530 |
15,943 |
$4.91M |
| D0140 |
Limited oral evaluation - problem focused |
2,466 |
2,266 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,683 |
1,563 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,111 |
5,572 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,487 |
1,435 |
$38K |
| D1110 |
Prophylaxis - adult |
1,026 |
1,012 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,965 |
1,922 |
$37K |
| D0330 |
Panoramic radiographic image |
1,762 |
1,599 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,512 |
2,524 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,827 |
1,728 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
389 |
365 |
$15K |
| D1999 |
|
1,122 |
854 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
151 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
229 |
120 |
$7K |
| D9992 |
|
453 |
434 |
$6K |
| D1354 |
|
1,453 |
273 |
$5K |
| D4341 |
|
94 |
72 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
166 |
165 |
$3K |
| D1120 |
Prophylaxis - child |
108 |
100 |
$2K |
| D0270 |
|
378 |
369 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$648.12 |