| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
39,270 |
31,806 |
$1.56M |
| D0140 |
Limited oral evaluation - problem focused |
7,424 |
5,709 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
15,430 |
12,884 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,077 |
2,542 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
7,114 |
5,804 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,503 |
2,066 |
$0.00 |
| D1310 |
|
114 |
113 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
10,920 |
9,092 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,404 |
1,376 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
5,019 |
2,318 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
451 |
346 |
$0.00 |
| D1351 |
Sealant - per tooth |
6,738 |
1,772 |
$0.00 |
| D0240 |
|
3,525 |
1,477 |
$0.00 |
| D1330 |
|
179 |
176 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
475 |
207 |
$0.00 |
| D0603 |
|
110 |
108 |
$0.00 |
| D2330 |
|
43 |
26 |
$0.00 |
| D2750 |
|
15 |
12 |
$0.00 |
| D0270 |
|
323 |
304 |
$0.00 |
| D1120 |
Prophylaxis - child |
11,332 |
9,363 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
829 |
528 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,892 |
1,079 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
10,463 |
8,216 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,716 |
2,084 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,879 |
2,438 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,537 |
1,444 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
831 |
696 |
$0.00 |
| D1354 |
|
2,996 |
855 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,524 |
2,991 |
$0.00 |
| D0190 |
|
3,298 |
2,909 |
$0.00 |
| D0330 |
Panoramic radiographic image |
2,411 |
2,001 |
$0.00 |
| D4910 |
|
141 |
122 |
$0.00 |
| D1510 |
|
105 |
65 |
$0.00 |
| D2950 |
|
109 |
92 |
$0.00 |