| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
52,481 |
46,855 |
$11.38M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,318 |
5,098 |
$390K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,763 |
4,743 |
$327K |
| D0120 |
Periodic oral evaluation - established patient |
11,103 |
10,856 |
$288K |
| D1206 |
Topical application of fluoride varnish |
12,653 |
12,374 |
$212K |
| D1110 |
Prophylaxis - adult |
4,733 |
4,635 |
$204K |
| D0220 |
Intraoral - periapical first radiographic image |
17,497 |
16,937 |
$150K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,204 |
3,097 |
$107K |
| D0274 |
Bitewings - four radiographic images |
8,512 |
8,283 |
$105K |
| D0330 |
Panoramic radiographic image |
2,967 |
2,883 |
$96K |
| D1120 |
Prophylaxis - child |
3,543 |
3,432 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,316 |
14,376 |
$58K |
| D4341 |
|
1,673 |
1,178 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
2,077 |
2,018 |
$46K |
| D1351 |
Sealant - per tooth |
1,339 |
522 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,243 |
2,172 |
$22K |
| D1999 |
|
1,260 |
1,077 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
140 |
133 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
373 |
343 |
$7K |
| D9992 |
|
356 |
351 |
$5K |
| D2331 |
|
15 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
26 |
$1K |
| D4910 |
|
15 |
15 |
$1K |