| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
78,890 |
70,752 |
$15.82M |
| D0120 |
Periodic oral evaluation - established patient |
17,821 |
17,606 |
$478K |
| D1206 |
Topical application of fluoride varnish |
17,648 |
17,446 |
$327K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,623 |
7,479 |
$264K |
| D0140 |
Limited oral evaluation - problem focused |
9,390 |
9,138 |
$245K |
| D1120 |
Prophylaxis - child |
9,272 |
9,166 |
$213K |
| D0220 |
Intraoral - periapical first radiographic image |
23,470 |
22,695 |
$205K |
| D4341 |
|
5,650 |
3,795 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,727 |
2,273 |
$189K |
| D1110 |
Prophylaxis - adult |
4,516 |
4,463 |
$188K |
| D0274 |
Bitewings - four radiographic images |
11,823 |
11,626 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,104 |
1,473 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,810 |
1,405 |
$96K |
| D0330 |
Panoramic radiographic image |
2,991 |
2,929 |
$91K |
| D4910 |
|
1,638 |
1,612 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
37,801 |
14,966 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,173 |
1,160 |
$51K |
| D4342 |
|
1,614 |
1,017 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,764 |
2,743 |
$27K |
| D0270 |
|
3,323 |
3,226 |
$22K |
| D1351 |
Sealant - per tooth |
649 |
179 |
$13K |
| D1999 |
|
568 |
514 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
517 |
509 |
$7K |
| D0190 |
|
548 |
540 |
$5K |
| D4346 |
|
50 |
50 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
58 |
$3K |
| D9992 |
|
142 |
137 |
$2K |
| D0240 |
|
188 |
93 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$280.00 |
| D1330 |
|
1,286 |
1,264 |
$0.00 |
| D1310 |
|
402 |
400 |
$0.00 |