| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
75,859 |
70,174 |
$16.36M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,242 |
9,385 |
$736K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,110 |
6,532 |
$508K |
| D0120 |
Periodic oral evaluation - established patient |
20,197 |
19,839 |
$497K |
| D1206 |
Topical application of fluoride varnish |
23,194 |
22,708 |
$373K |
| D1120 |
Prophylaxis - child |
15,656 |
15,395 |
$358K |
| D0220 |
Intraoral - periapical first radiographic image |
30,559 |
29,745 |
$253K |
| D0140 |
Limited oral evaluation - problem focused |
8,216 |
7,932 |
$199K |
| D1110 |
Prophylaxis - adult |
4,353 |
4,242 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,886 |
3,794 |
$134K |
| D0272 |
Bitewings - two radiographic images |
10,696 |
10,534 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,407 |
23,718 |
$101K |
| D0274 |
Bitewings - four radiographic images |
8,435 |
8,274 |
$100K |
| D1351 |
Sealant - per tooth |
3,690 |
1,499 |
$80K |
| D4341 |
|
1,739 |
1,367 |
$52K |
| D0330 |
Panoramic radiographic image |
1,277 |
1,239 |
$44K |
| D1999 |
|
2,445 |
2,308 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
312 |
282 |
$20K |
| D9992 |
|
1,224 |
1,215 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
176 |
$11K |
| D0270 |
|
1,139 |
1,051 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
478 |
431 |
$7K |
| D0190 |
|
539 |
450 |
$2K |
| D2331 |
|
15 |
13 |
$809.72 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$260.00 |