| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
15,807 |
12,458 |
$1.09M |
| D1110 |
Prophylaxis - adult |
3,500 |
2,519 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
5,714 |
4,104 |
$28K |
| D0330 |
Panoramic radiographic image |
2,899 |
2,094 |
$27K |
| D1120 |
Prophylaxis - child |
5,573 |
4,049 |
$27K |
| D1206 |
Topical application of fluoride varnish |
6,557 |
4,758 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,449 |
3,238 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
985 |
462 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
813 |
399 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,943 |
1,368 |
$9K |
| D0274 |
Bitewings - four radiographic images |
2,796 |
2,192 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
124 |
55 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
426 |
267 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,622 |
1,766 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
366 |
286 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
720 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
52 |
16 |
$1K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
29 |
13 |
$1K |
| D1351 |
Sealant - per tooth |
343 |
99 |
$616.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
621 |
198 |
$160.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
40 |
$153.63 |
| 80305 |
|
27 |
12 |
$111.10 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
14 |
$50.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
54 |
16 |
$0.00 |
| D0350 |
|
20 |
18 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
30 |
16 |
$0.00 |
| D1330 |
|
879 |
850 |
$0.00 |
| D0603 |
|
371 |
360 |
$0.00 |
| D0602 |
|
116 |
114 |
$0.00 |
| D4999 |
|
72 |
71 |
$0.00 |
| D0601 |
|
109 |
106 |
$0.00 |
| D2160 |
|
21 |
16 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
97 |
94 |
$0.00 |