| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
67,556 |
62,343 |
$12.40M |
| D0120 |
Periodic oral evaluation - established patient |
18,158 |
18,012 |
$476K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,574 |
5,580 |
$462K |
| D1110 |
Prophylaxis - adult |
4,228 |
4,151 |
$174K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,759 |
2,492 |
$170K |
| D1206 |
Topical application of fluoride varnish |
9,243 |
9,170 |
$168K |
| D0330 |
Panoramic radiographic image |
5,330 |
5,259 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,345 |
2,202 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
18,477 |
18,052 |
$153K |
| D0274 |
Bitewings - four radiographic images |
12,328 |
12,189 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
6,542 |
6,213 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,504 |
4,424 |
$148K |
| D1120 |
Prophylaxis - child |
4,619 |
4,594 |
$105K |
| D4910 |
|
1,693 |
1,644 |
$90K |
| D1999 |
|
4,543 |
4,207 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
694 |
577 |
$50K |
| D4341 |
|
1,573 |
819 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,735 |
2,705 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,821 |
12,684 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
368 |
362 |
$11K |
| D0272 |
Bitewings - two radiographic images |
502 |
502 |
$5K |
| D0270 |
|
641 |
595 |
$4K |
| D4342 |
|
260 |
90 |
$3K |
| D1351 |
Sealant - per tooth |
76 |
26 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
14 |
$950.45 |
| D2331 |
|
19 |
12 |
$838.40 |
| D2330 |
|
16 |
12 |
$565.48 |