| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
70,789 |
62,893 |
$15.03M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,717 |
9,494 |
$762K |
| D0120 |
Periodic oral evaluation - established patient |
16,211 |
15,790 |
$400K |
| D1206 |
Topical application of fluoride varnish |
21,309 |
20,752 |
$344K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,899 |
5,299 |
$328K |
| D1120 |
Prophylaxis - child |
12,576 |
12,229 |
$280K |
| D0330 |
Panoramic radiographic image |
6,225 |
6,062 |
$205K |
| D0220 |
Intraoral - periapical first radiographic image |
24,446 |
23,695 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,655 |
5,475 |
$187K |
| D0140 |
Limited oral evaluation - problem focused |
6,678 |
6,440 |
$154K |
| D1110 |
Prophylaxis - adult |
3,478 |
3,394 |
$143K |
| D0274 |
Bitewings - four radiographic images |
10,050 |
9,809 |
$108K |
| D4341 |
|
3,519 |
2,864 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,296 |
1,135 |
$90K |
| D1351 |
Sealant - per tooth |
3,800 |
1,664 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
34,942 |
18,229 |
$71K |
| D0272 |
Bitewings - two radiographic images |
7,536 |
7,335 |
$70K |
| D1999 |
|
1,883 |
1,756 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
569 |
382 |
$20K |
| D9992 |
|
1,051 |
1,039 |
$15K |
| D0270 |
|
2,647 |
2,583 |
$14K |
| D4910 |
|
52 |
52 |
$2K |
| D2331 |
|
40 |
36 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
63 |
61 |
$1K |
| D4342 |
|
53 |
36 |
$992.77 |