| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
69,903 |
65,285 |
$8.29M |
| D1206 |
Topical application of fluoride varnish |
30,340 |
29,553 |
$13K |
| D1120 |
Prophylaxis - child |
23,989 |
23,384 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,905 |
5,151 |
$9K |
| D1351 |
Sealant - per tooth |
15,445 |
5,008 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
26,479 |
24,078 |
$5K |
| D0330 |
Panoramic radiographic image |
6,595 |
6,404 |
$3K |
| D1354 |
|
4,869 |
1,718 |
$2K |
| D0274 |
Bitewings - four radiographic images |
10,824 |
10,548 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,692 |
3,045 |
$2K |
| D0272 |
Bitewings - two radiographic images |
5,413 |
5,279 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,311 |
8,051 |
$1K |
| D1110 |
Prophylaxis - adult |
8,784 |
8,618 |
$960.00 |
| D0140 |
Limited oral evaluation - problem focused |
6,023 |
5,841 |
$750.00 |
| D0220 |
Intraoral - periapical first radiographic image |
7,760 |
7,371 |
$504.00 |
| D0240 |
|
77 |
74 |
$0.00 |
| D7220 |
|
13 |
12 |
$0.00 |
| D1330 |
|
2,575 |
2,429 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,109 |
2,379 |
$0.00 |
| D7111 |
|
916 |
619 |
$0.00 |
| D0603 |
|
587 |
557 |
$0.00 |
| D9310 |
|
581 |
566 |
$0.00 |
| D9992 |
|
457 |
445 |
$0.00 |
| D0602 |
|
1,516 |
1,457 |
$0.00 |
| D2331 |
|
32 |
26 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$0.00 |
| D1310 |
|
47 |
47 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$0.00 |
| D2160 |
|
13 |
12 |
$0.00 |
| D0170 |
|
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D7240 |
Removal of impacted tooth - completely bony |
17 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
652 |
642 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,124 |
1,719 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,894 |
4,512 |
$0.00 |
| D2140 |
|
1,167 |
895 |
$0.00 |
| D9430 |
|
27 |
24 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
982 |
976 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
457 |
410 |
$0.00 |
| D0270 |
|
177 |
176 |
$0.00 |
| D2940 |
|
169 |
124 |
$0.00 |
| D9110 |
|
14 |
13 |
$0.00 |