| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
16,027 |
13,944 |
$3.19M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,489 |
1,294 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
4,162 |
4,133 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,371 |
1,108 |
$87K |
| D1120 |
Prophylaxis - child |
3,070 |
3,056 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,339 |
912 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,887 |
2,756 |
$66K |
| D0330 |
Panoramic radiographic image |
1,575 |
1,562 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,308 |
1,301 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,371 |
2,349 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,185 |
3,504 |
$31K |
| D1110 |
Prophylaxis - adult |
723 |
717 |
$29K |
| D0274 |
Bitewings - four radiographic images |
2,107 |
2,083 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,240 |
1,238 |
$20K |
| D1351 |
Sealant - per tooth |
841 |
246 |
$15K |
| D4341 |
|
274 |
173 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,244 |
1,240 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
347 |
343 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,887 |
1,607 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
41 |
$5K |
| D9110 |
|
73 |
71 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
38 |
$3K |
| D0190 |
|
221 |
218 |
$2K |
| D1330 |
|
172 |
170 |
$2K |
| D2330 |
|
26 |
13 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D9992 |
|
33 |
33 |
$495.00 |
| D0270 |
|
41 |
39 |
$275.52 |
| D0460 |
|
18 |
13 |
$14.55 |