| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
26,391 |
20,670 |
$5.57M |
| D7140 |
Extraction, erupted tooth or exposed root |
337 |
223 |
$528.00 |
| D1110 |
Prophylaxis - adult |
2,130 |
2,108 |
$363.00 |
| D0274 |
Bitewings - four radiographic images |
1,410 |
1,400 |
$284.90 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,176 |
1,167 |
$154.00 |
| D2332 |
|
124 |
92 |
$137.50 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
640 |
487 |
$125.40 |
| D0220 |
Intraoral - periapical first radiographic image |
1,550 |
1,521 |
$116.50 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
374 |
289 |
$102.30 |
| D0120 |
Periodic oral evaluation - established patient |
2,212 |
2,192 |
$82.50 |
| D0330 |
Panoramic radiographic image |
710 |
705 |
$73.70 |
| 3074F |
|
182 |
160 |
$60.00 |
| 3078F |
|
110 |
97 |
$50.00 |
| 3008F |
|
173 |
156 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
287 |
248 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,049 |
1,032 |
$0.00 |
| D1351 |
Sealant - per tooth |
231 |
55 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
164 |
164 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
831 |
809 |
$0.00 |
| D2331 |
|
137 |
113 |
$0.00 |
| D2330 |
|
150 |
118 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
28 |
$0.00 |
| 2001F |
|
108 |
98 |
$0.00 |
| 1111F |
|
61 |
56 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
283 |
282 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
265 |
233 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
231 |
231 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
194 |
$0.00 |
| D1330 |
|
924 |
922 |
$0.00 |
| D5899 |
|
194 |
175 |
$0.00 |
| D2335 |
|
95 |
81 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
15 |
12 |
$0.00 |
| 1159F |
|
242 |
213 |
$0.00 |
| D1120 |
Prophylaxis - child |
991 |
976 |
$0.00 |
| D9110 |
|
693 |
678 |
$0.00 |
| D1999 |
|
33 |
33 |
$0.00 |