| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,772 |
1,701 |
$489K |
| D1110 |
Prophylaxis - adult |
791 |
757 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
257 |
$14K |
| D0274 |
Bitewings - four radiographic images |
902 |
850 |
$11K |
| D1206 |
Topical application of fluoride varnish |
951 |
904 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,629 |
1,506 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
862 |
810 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,714 |
1,170 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
482 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
138 |
$6K |
| D1120 |
Prophylaxis - child |
297 |
287 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
357 |
328 |
$4K |
| 90834 |
Psychotherapy, 45 minutes with patient |
167 |
80 |
$4K |
| D0330 |
Panoramic radiographic image |
235 |
215 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
57 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
129 |
99 |
$3K |
| D0272 |
Bitewings - two radiographic images |
50 |
48 |
$434.29 |
| 3008F |
|
438 |
347 |
$0.00 |
| D1330 |
|
1,516 |
1,373 |
$0.00 |
| D0603 |
|
386 |
368 |
$0.00 |
| 1170F |
|
21 |
12 |
$0.00 |
| D0602 |
|
55 |
54 |
$0.00 |
| 3074F |
|
100 |
81 |
$0.00 |
| 1159F |
|
541 |
402 |
$0.00 |
| 1160F |
|
541 |
402 |
$0.00 |
| 3078F |
|
77 |
52 |
$0.00 |