| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
61,756 |
51,562 |
$13.88M |
| D0120 |
Periodic oral evaluation - established patient |
20,050 |
19,137 |
$460K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,082 |
2,995 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,996 |
2,472 |
$187K |
| D1110 |
Prophylaxis - adult |
4,004 |
3,793 |
$152K |
| D1206 |
Topical application of fluoride varnish |
9,118 |
8,691 |
$151K |
| D4341 |
|
4,399 |
2,138 |
$131K |
| D1120 |
Prophylaxis - child |
5,302 |
5,066 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,721 |
2,642 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
14,345 |
13,669 |
$104K |
| D4910 |
|
2,438 |
2,298 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
4,675 |
4,395 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,024 |
1,966 |
$66K |
| D0274 |
Bitewings - four radiographic images |
5,787 |
5,595 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,284 |
758 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,759 |
9,700 |
$24K |
| D2330 |
|
313 |
213 |
$10K |
| D1351 |
Sealant - per tooth |
333 |
103 |
$6K |
| D4342 |
|
343 |
137 |
$4K |
| D9992 |
|
248 |
234 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
116 |
116 |
$3K |
| D1999 |
|
266 |
210 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
148 |
144 |
$2K |
| D2331 |
|
35 |
26 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
18 |
$1K |
| D0272 |
Bitewings - two radiographic images |
97 |
95 |
$901.74 |
| D0270 |
|
78 |
76 |
$531.60 |
| D1330 |
|
56 |
54 |
$0.00 |
| D0603 |
|
73 |
73 |
$0.00 |