| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
20,797 |
17,443 |
$7.29M |
| D1206 |
Topical application of fluoride varnish |
5,691 |
5,259 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,716 |
2,582 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
2,184 |
1,844 |
$49K |
| D1351 |
Sealant - per tooth |
4,809 |
842 |
$47K |
| D1110 |
Prophylaxis - adult |
1,707 |
1,528 |
$43K |
| D1120 |
Prophylaxis - child |
2,039 |
1,949 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,326 |
4,045 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
558 |
414 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,063 |
954 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
283 |
211 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,131 |
1,044 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
302 |
293 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,329 |
2,178 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
83 |
$7K |
| D9630 |
|
891 |
728 |
$6K |
| D0330 |
Panoramic radiographic image |
179 |
166 |
$6K |
| D0272 |
Bitewings - two radiographic images |
222 |
218 |
$2K |
| D8660 |
|
12 |
12 |
$2K |
| D4910 |
|
61 |
51 |
$2K |
| D1354 |
|
200 |
72 |
$692.40 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$515.20 |
| D0270 |
|
43 |
40 |
$344.16 |
| D0190 |
|
271 |
269 |
$30.60 |
| D0460 |
|
76 |
15 |
$19.40 |
| D0180 |
|
1,277 |
1,221 |
$0.00 |
| D0350 |
|
17 |
13 |
$0.00 |
| D8680 |
|
13 |
12 |
$0.00 |
| D0801 |
|
12 |
12 |
$0.00 |
| D1330 |
|
3,927 |
3,517 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
743 |
664 |
$0.00 |
| D9215 |
|
1,789 |
1,643 |
$0.00 |
| D1355 |
|
569 |
536 |
$0.00 |
| D0603 |
|
437 |
413 |
$0.00 |
| D9310 |
|
711 |
653 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |
| D0470 |
|
19 |
14 |
$0.00 |
| D5899 |
|
73 |
27 |
$0.00 |