| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,540 |
14,261 |
$3.27M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
829 |
822 |
$264K |
| D0120 |
Periodic oral evaluation - established patient |
5,474 |
5,417 |
$141K |
| D1120 |
Prophylaxis - child |
3,890 |
3,851 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,664 |
1,056 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,225 |
4,149 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
960 |
731 |
$64K |
| D0330 |
Panoramic radiographic image |
1,433 |
1,418 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
2,036 |
1,907 |
$45K |
| D1110 |
Prophylaxis - adult |
858 |
845 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,911 |
2,871 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,689 |
3,184 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,226 |
1,225 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
410 |
237 |
$20K |
| D1351 |
Sealant - per tooth |
979 |
353 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
439 |
430 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,640 |
1,629 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,692 |
1,714 |
$11K |
| D0270 |
|
561 |
549 |
$3K |
| D0190 |
|
256 |
253 |
$2K |
| D1330 |
|
182 |
181 |
$2K |
| D4341 |
|
46 |
29 |
$2K |
| D0170 |
|
44 |
36 |
$685.10 |
| D9110 |
|
16 |
13 |
$509.32 |
| D0160 |
|
12 |
12 |
$431.80 |
| D9992 |
|
15 |
15 |
$225.00 |
| D0340 |
|
34 |
34 |
$0.00 |