| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
40,031 |
34,743 |
$8.59M |
| D0120 |
Periodic oral evaluation - established patient |
11,300 |
11,052 |
$271K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,592 |
2,887 |
$210K |
| D1206 |
Topical application of fluoride varnish |
10,163 |
9,907 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,242 |
2,277 |
$161K |
| D1110 |
Prophylaxis - adult |
4,039 |
3,953 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
13,780 |
13,366 |
$113K |
| D1120 |
Prophylaxis - child |
4,454 |
4,338 |
$100K |
| D0274 |
Bitewings - four radiographic images |
7,454 |
7,301 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,547 |
2,503 |
$82K |
| D0330 |
Panoramic radiographic image |
1,865 |
1,832 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,325 |
11,344 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
2,001 |
1,850 |
$40K |
| D4341 |
|
1,071 |
703 |
$29K |
| D1999 |
|
1,755 |
1,615 |
$22K |
| D0272 |
Bitewings - two radiographic images |
2,144 |
2,094 |
$21K |
| D1351 |
Sealant - per tooth |
516 |
186 |
$10K |
| D9992 |
|
327 |
319 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$2K |
| D2331 |
|
16 |
14 |
$693.38 |
| D9995 |
|
41 |
41 |
$400.00 |
| D0270 |
|
81 |
60 |
$232.80 |