| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
24,884 |
22,047 |
$4.68M |
| D0120 |
Periodic oral evaluation - established patient |
7,188 |
7,101 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,736 |
2,134 |
$141K |
| D0330 |
Panoramic radiographic image |
2,691 |
2,653 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,349 |
1,154 |
$88K |
| D1110 |
Prophylaxis - adult |
1,797 |
1,781 |
$75K |
| D1120 |
Prophylaxis - child |
3,135 |
3,087 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,523 |
1,492 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
2,358 |
2,254 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,544 |
3,497 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,232 |
2,202 |
$47K |
| D4341 |
|
1,136 |
774 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,343 |
1,321 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,793 |
1,761 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,785 |
1,728 |
$17K |
| D4910 |
|
66 |
66 |
$5K |
| D4346 |
|
51 |
51 |
$3K |
| D4342 |
|
244 |
151 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$788.04 |
| D1351 |
Sealant - per tooth |
25 |
14 |
$646.17 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$420.00 |