| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
51,500 |
44,504 |
$11.88M |
| D0120 |
Periodic oral evaluation - established patient |
17,277 |
16,511 |
$409K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,573 |
3,602 |
$281K |
| D1206 |
Topical application of fluoride varnish |
10,971 |
10,568 |
$188K |
| D0210 |
Intraoral - complete series of radiographic images |
4,004 |
3,889 |
$160K |
| D4341 |
|
4,389 |
2,501 |
$152K |
| D1120 |
Prophylaxis - child |
5,954 |
5,741 |
$134K |
| D1110 |
Prophylaxis - adult |
3,269 |
3,175 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,494 |
1,826 |
$118K |
| D4910 |
|
1,821 |
1,750 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
11,287 |
10,844 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,494 |
2,429 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
3,474 |
3,276 |
$75K |
| D0274 |
Bitewings - four radiographic images |
4,486 |
4,344 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,319 |
2,193 |
$26K |
| D1999 |
|
1,776 |
1,462 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,722 |
7,602 |
$18K |
| D1351 |
Sealant - per tooth |
722 |
261 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
379 |
218 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
106 |
$10K |
| D9992 |
|
368 |
352 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
148 |
148 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
38 |
37 |
$474.72 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$123.48 |
| 90686 |
|
13 |
13 |
$114.18 |
| D0270 |
|
12 |
12 |
$68.64 |
| D0603 |
|
38 |
37 |
$0.00 |
| D1330 |
|
40 |
40 |
$0.00 |