| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
21,236 |
19,571 |
$8.07M |
| D0140 |
Limited oral evaluation - problem focused |
2,914 |
2,739 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,544 |
6,172 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,363 |
3,246 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
2,028 |
1,993 |
$50K |
| D0415 |
|
1,436 |
1,401 |
$29K |
| D1120 |
Prophylaxis - child |
1,578 |
1,537 |
$27K |
| D1351 |
Sealant - per tooth |
2,642 |
435 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
220 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,252 |
2,740 |
$16K |
| D1999 |
|
1,171 |
1,064 |
$15K |
| D0330 |
Panoramic radiographic image |
634 |
581 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
349 |
133 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,068 |
1,014 |
$11K |
| D0604 |
|
1,436 |
1,401 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
493 |
443 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
208 |
206 |
$6K |
| D1110 |
Prophylaxis - adult |
110 |
110 |
$4K |
| D9992 |
|
205 |
198 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
40 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$3K |
| D9995 |
|
248 |
236 |
$2K |
| D0272 |
Bitewings - two radiographic images |
107 |
107 |
$976.99 |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$908.04 |
| D0270 |
|
174 |
168 |
$783.84 |
| D1354 |
|
42 |
13 |
$96.00 |
| D0191 |
|
183 |
180 |
$91.80 |
| D1330 |
|
338 |
334 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
629 |
609 |
$0.00 |
| D1355 |
|
44 |
37 |
$0.00 |
| D0470 |
|
13 |
13 |
$0.00 |
| D0603 |
|
23 |
23 |
$0.00 |
| D0190 |
|
17 |
17 |
$0.00 |
| D0350 |
|
42 |
41 |
$0.00 |
| D8660 |
|
12 |
12 |
$0.00 |