| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
43,622 |
39,781 |
$18.31M |
| D0120 |
Periodic oral evaluation - established patient |
21,573 |
21,135 |
$547K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,814 |
1,416 |
$473K |
| D1120 |
Prophylaxis - child |
17,837 |
17,441 |
$403K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,174 |
3,132 |
$340K |
| D1206 |
Topical application of fluoride varnish |
15,994 |
15,928 |
$304K |
| D1351 |
Sealant - per tooth |
9,756 |
3,002 |
$198K |
| D1110 |
Prophylaxis - adult |
5,979 |
5,823 |
$197K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,798 |
1,408 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,589 |
1,864 |
$134K |
| D0220 |
Intraoral - periapical first radiographic image |
14,240 |
13,890 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,475 |
2,414 |
$95K |
| D0272 |
Bitewings - two radiographic images |
9,756 |
9,565 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,100 |
4,659 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,982 |
2,624 |
$64K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
751 |
438 |
$63K |
| D0330 |
Panoramic radiographic image |
1,597 |
1,582 |
$59K |
| D0274 |
Bitewings - four radiographic images |
4,010 |
3,916 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,474 |
12,558 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
915 |
833 |
$17K |
| D2331 |
|
116 |
63 |
$9K |
| D0270 |
|
1,112 |
1,088 |
$8K |
| D4341 |
|
19 |
12 |
$822.12 |
| D1354 |
|
256 |
72 |
$814.20 |
| D4910 |
|
12 |
12 |
$368.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$354.20 |
| D3120 |
|
48 |
31 |
$0.00 |