| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
47,895 |
41,600 |
$8.10M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,163 |
4,904 |
$397K |
| D0120 |
Periodic oral evaluation - established patient |
12,748 |
12,520 |
$338K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,535 |
4,116 |
$277K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,192 |
2,731 |
$224K |
| D0140 |
Limited oral evaluation - problem focused |
6,942 |
6,668 |
$174K |
| D1110 |
Prophylaxis - adult |
3,565 |
3,516 |
$141K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,493 |
3,429 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,755 |
2,691 |
$113K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,060 |
956 |
$86K |
| D0274 |
Bitewings - four radiographic images |
6,373 |
6,263 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,471 |
4,417 |
$69K |
| D1120 |
Prophylaxis - child |
2,901 |
2,866 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
6,961 |
6,728 |
$64K |
| D1999 |
|
2,337 |
2,105 |
$30K |
| D0330 |
Panoramic radiographic image |
969 |
958 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
729 |
636 |
$14K |
| D2331 |
|
179 |
140 |
$10K |
| D0270 |
|
1,087 |
1,052 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
205 |
184 |
$7K |
| D2394 |
|
84 |
77 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
640 |
597 |
$6K |
| D4341 |
|
153 |
121 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
234 |
210 |
$5K |
| D2330 |
|
88 |
67 |
$4K |
| D1206 |
Topical application of fluoride varnish |
159 |
153 |
$4K |
| D0272 |
Bitewings - two radiographic images |
401 |
394 |
$4K |
| D1351 |
Sealant - per tooth |
111 |
43 |
$2K |
| D2335 |
|
34 |
26 |
$2K |
| D0240 |
|
145 |
74 |
$1K |
| D0603 |
|
1,076 |
1,067 |
$0.00 |
| D0602 |
|
685 |
675 |
$0.00 |
| D0601 |
|
630 |
626 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
20 |
20 |
$0.00 |