| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
25,428 |
22,472 |
$4.22M |
| D0220 |
Intraoral - periapical first radiographic image |
4,549 |
4,437 |
$0.00 |
| D1110 |
Prophylaxis - adult |
7,022 |
6,938 |
$0.00 |
| D0270 |
|
393 |
378 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,378 |
2,362 |
$0.00 |
| D1120 |
Prophylaxis - child |
313 |
310 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
186 |
145 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
193 |
174 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
28 |
$0.00 |
| D2940 |
|
13 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
353 |
196 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,304 |
1,282 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,800 |
3,760 |
$0.00 |
| D1330 |
|
4,357 |
4,344 |
$0.00 |
| D0602 |
|
384 |
383 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
3,360 |
3,293 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,328 |
1,304 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,642 |
912 |
$0.00 |
| D0603 |
|
812 |
808 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
57 |
57 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
526 |
518 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
175 |
$0.00 |
| D0601 |
|
41 |
40 |
$0.00 |
| D2335 |
|
18 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$0.00 |
| D2160 |
|
14 |
12 |
$0.00 |
| D2331 |
|
13 |
12 |
$0.00 |