| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,166 |
3,722 |
$648K |
| D1206 |
Topical application of fluoride varnish |
3,338 |
2,599 |
$100K |
| D1120 |
Prophylaxis - child |
2,395 |
1,924 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,155 |
1,661 |
$27K |
| D1110 |
Prophylaxis - adult |
1,761 |
1,450 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,771 |
1,393 |
$19K |
| D1351 |
Sealant - per tooth |
636 |
183 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
99 |
$7K |
| D0330 |
Panoramic radiographic image |
709 |
553 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
449 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
57 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
737 |
343 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
311 |
237 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
630 |
513 |
$1K |
| D0272 |
Bitewings - two radiographic images |
61 |
45 |
$761.61 |
| D9992 |
|
13 |
13 |
$286.00 |
| D2330 |
|
17 |
12 |
$100.00 |