| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,051 |
4,799 |
$166K |
| D0330 |
Panoramic radiographic image |
4,145 |
2,324 |
$55K |
| D1110 |
Prophylaxis - adult |
2,875 |
1,692 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
963 |
478 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,439 |
1,383 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
2,346 |
1,280 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,599 |
1,971 |
$18K |
| D0274 |
Bitewings - four radiographic images |
3,084 |
1,801 |
$13K |
| D1206 |
Topical application of fluoride varnish |
1,646 |
1,036 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
952 |
591 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
4,242 |
2,438 |
$6K |
| D1120 |
Prophylaxis - child |
176 |
173 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
26 |
$924.72 |
| D0602 |
|
285 |
164 |
$0.00 |
| D1330 |
|
993 |
658 |
$0.00 |
| D0601 |
|
69 |
50 |
$0.00 |
| D0603 |
|
27 |
12 |
$0.00 |