| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,699 |
6,824 |
$1.33M |
| D1120 |
Prophylaxis - child |
946 |
641 |
$33K |
| D1110 |
Prophylaxis - adult |
3,732 |
3,415 |
$18K |
| D1206 |
Topical application of fluoride varnish |
568 |
399 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,977 |
1,660 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
528 |
352 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,370 |
1,137 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
279 |
184 |
$8K |
| D1351 |
Sealant - per tooth |
415 |
86 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
615 |
537 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
1,069 |
971 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
102 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
109 |
81 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,664 |
1,518 |
$3K |
| D0272 |
Bitewings - two radiographic images |
188 |
131 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
701 |
677 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
65 |
$810.00 |
| D2140 |
|
23 |
16 |
$720.00 |
| D0330 |
Panoramic radiographic image |
21 |
15 |
$700.00 |
| D2335 |
|
37 |
27 |
$344.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
855 |
444 |
$344.00 |
| D2940 |
|
31 |
25 |
$140.00 |
| D2950 |
|
48 |
47 |
$110.00 |
| D0270 |
|
212 |
203 |
$60.00 |
| D1330 |
|
1,163 |
1,161 |
$0.00 |
| D0603 |
|
120 |
119 |
$0.00 |
| D0602 |
|
50 |
50 |
$0.00 |