| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
71,474 |
60,609 |
$8.33M |
| D0220 |
Intraoral - periapical first radiographic image |
22,450 |
19,958 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12,005 |
10,857 |
$0.00 |
| D1110 |
Prophylaxis - adult |
9,997 |
9,387 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,861 |
1,481 |
$0.00 |
| D1120 |
Prophylaxis - child |
11,234 |
10,881 |
$0.00 |
| D0190 |
|
794 |
417 |
$0.00 |
| D0191 |
|
42 |
28 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
24 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$0.00 |
| D2140 |
|
20 |
19 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
15,685 |
14,830 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
4,127 |
3,836 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
2,256 |
2,169 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,372 |
15,992 |
$0.00 |
| D0602 |
|
429 |
377 |
$0.00 |
| D1351 |
Sealant - per tooth |
3,887 |
1,408 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,210 |
1,001 |
$0.00 |
| D5899 |
|
750 |
544 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,402 |
6,926 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
7,074 |
6,853 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
4,784 |
4,627 |
$0.00 |
| D0601 |
|
688 |
630 |
$0.00 |
| D0603 |
|
124 |
117 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
51 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |