| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,819 |
8,947 |
$1.61M |
| D1206 |
Topical application of fluoride varnish |
2,123 |
1,274 |
$35K |
| D1120 |
Prophylaxis - child |
1,403 |
915 |
$30K |
| D1110 |
Prophylaxis - adult |
5,090 |
4,509 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
2,429 |
1,939 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,374 |
1,142 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
906 |
803 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,421 |
1,239 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
313 |
290 |
$1K |
| D9992 |
|
346 |
310 |
$550.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
200 |
161 |
$480.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
48 |
$440.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
38 |
$48.00 |
| D0270 |
|
17 |
14 |
$36.00 |
| D1330 |
|
1,028 |
1,024 |
$0.00 |
| D0603 |
|
159 |
158 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
125 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
30 |
30 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
51 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
110 |
109 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
18 |
$0.00 |
| D2140 |
|
18 |
14 |
$0.00 |