| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
25,766 |
15,620 |
$1.73M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
11,172 |
5,272 |
$242K |
| D1351 |
Sealant - per tooth |
10,893 |
1,640 |
$61K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
1,635 |
927 |
$54K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,300 |
660 |
$41K |
| D1110 |
Prophylaxis - adult |
3,739 |
2,646 |
$36K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,274 |
2,033 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
5,022 |
3,442 |
$25K |
| D0274 |
Bitewings - four radiographic images |
4,834 |
3,168 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,401 |
2,908 |
$18K |
| D1206 |
Topical application of fluoride varnish |
3,133 |
2,182 |
$17K |
| D1354 |
|
3,443 |
1,261 |
$16K |
| D1120 |
Prophylaxis - child |
2,566 |
1,780 |
$15K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
992 |
632 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
690 |
301 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,137 |
1,370 |
$12K |
| D0330 |
Panoramic radiographic image |
1,805 |
1,074 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
711 |
383 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
5,008 |
3,325 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,316 |
1,764 |
$6K |
| 90651 |
|
65 |
49 |
$6K |
| 96160 |
|
3,314 |
1,845 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
34 |
24 |
$3K |
| D2140 |
|
420 |
187 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
112 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
44 |
$2K |
| 94010 |
|
159 |
92 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
193 |
$1K |
| 99384 |
|
14 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
631 |
432 |
$870.90 |
| 90686 |
|
137 |
84 |
$740.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$716.82 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
42 |
$102.42 |
| D2160 |
|
87 |
25 |
$65.00 |
| 90658 |
|
117 |
61 |
$20.00 |
| 90713 |
|
26 |
18 |
$10.00 |
| 3008F |
|
2,272 |
1,096 |
$0.00 |
| 3074F |
|
5,010 |
3,725 |
$0.00 |
| 3079F |
|
488 |
276 |
$0.00 |
| D0603 |
|
200 |
172 |
$0.00 |
| 90744 |
|
17 |
13 |
$0.00 |
| 3078F |
|
6,415 |
3,539 |
$0.00 |
| 90734 |
|
163 |
98 |
$0.00 |