| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,183 |
6,019 |
$2.05M |
| D1999 |
|
4,365 |
3,844 |
$41K |
| D1206 |
Topical application of fluoride varnish |
3,372 |
2,880 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
777 |
530 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
718 |
717 |
$18K |
| D1351 |
Sealant - per tooth |
1,912 |
536 |
$16K |
| D1120 |
Prophylaxis - child |
1,585 |
1,585 |
$16K |
| D1110 |
Prophylaxis - adult |
1,192 |
1,191 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
704 |
221 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,543 |
1,542 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,827 |
1,826 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,831 |
1,830 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
132 |
85 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
492 |
486 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
135 |
$4K |
| D0330 |
Panoramic radiographic image |
1,020 |
1,020 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
677 |
669 |
$2K |
| D2160 |
|
16 |
14 |
$1K |
| D4355 |
|
12 |
12 |
$552.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
685 |
571 |
$0.01 |
| D0603 |
|
585 |
585 |
$0.00 |
| D0602 |
|
401 |
401 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$0.00 |
| D7111 |
|
24 |
14 |
$0.00 |
| D1354 |
|
158 |
50 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
25 |
$0.00 |