| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
163,975 |
135,263 |
$18.92M |
| D0120 |
Periodic oral evaluation - established patient |
58,182 |
53,700 |
$1.36M |
| D1206 |
Topical application of fluoride varnish |
56,576 |
51,632 |
$847K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,647 |
8,709 |
$754K |
| D1120 |
Prophylaxis - child |
32,365 |
29,834 |
$676K |
| D1110 |
Prophylaxis - adult |
18,493 |
16,724 |
$581K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,288 |
6,806 |
$487K |
| D0330 |
Panoramic radiographic image |
16,209 |
14,858 |
$481K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,434 |
5,783 |
$471K |
| D4341 |
|
12,448 |
7,581 |
$402K |
| D0140 |
Limited oral evaluation - problem focused |
14,238 |
12,931 |
$353K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,300 |
10,266 |
$344K |
| D0272 |
Bitewings - two radiographic images |
28,719 |
26,569 |
$237K |
| D0274 |
Bitewings - four radiographic images |
21,594 |
19,725 |
$217K |
| D0220 |
Intraoral - periapical first radiographic image |
23,942 |
21,553 |
$197K |
| D9999 |
Unspecified adjunctive procedure, by report |
9,013 |
8,289 |
$175K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,016 |
790 |
$91K |
| D1351 |
Sealant - per tooth |
3,103 |
870 |
$58K |
| D4910 |
|
810 |
707 |
$35K |
| D3221 |
|
433 |
390 |
$27K |
| D2331 |
|
288 |
209 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,582 |
6,630 |
$23K |
| D2330 |
|
383 |
229 |
$20K |
| D0190 |
|
1,653 |
1,498 |
$17K |
| D1330 |
|
1,585 |
1,431 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
441 |
374 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
146 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
41 |
$4K |
| D1354 |
|
1,265 |
316 |
$4K |
| D2332 |
|
27 |
24 |
$3K |
| D0160 |
|
51 |
49 |
$2K |
| D9110 |
|
65 |
44 |
$2K |
| D2394 |
|
16 |
13 |
$2K |
| D4346 |
|
13 |
12 |
$808.00 |