| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
101,298 |
84,107 |
$20.91M |
| D0120 |
Periodic oral evaluation - established patient |
22,779 |
22,630 |
$605K |
| D1110 |
Prophylaxis - adult |
9,520 |
9,459 |
$414K |
| D0140 |
Limited oral evaluation - problem focused |
16,189 |
15,666 |
$409K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,256 |
4,975 |
$363K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,853 |
4,592 |
$360K |
| D1206 |
Topical application of fluoride varnish |
19,224 |
19,109 |
$327K |
| D0220 |
Intraoral - periapical first radiographic image |
35,448 |
34,625 |
$310K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,961 |
4,279 |
$296K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,607 |
6,554 |
$229K |
| D1120 |
Prophylaxis - child |
8,219 |
8,181 |
$190K |
| D0210 |
Intraoral - complete series of radiographic images |
3,936 |
3,909 |
$157K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,143 |
933 |
$119K |
| D0274 |
Bitewings - four radiographic images |
10,593 |
10,531 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,698 |
19,806 |
$103K |
| D0330 |
Panoramic radiographic image |
2,026 |
2,009 |
$76K |
| D1351 |
Sealant - per tooth |
3,184 |
1,337 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
805 |
680 |
$58K |
| D4341 |
|
1,562 |
1,006 |
$46K |
| D0272 |
Bitewings - two radiographic images |
4,215 |
4,199 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,532 |
1,434 |
$36K |
| D1999 |
|
2,276 |
1,949 |
$26K |
| D1354 |
|
4,679 |
1,163 |
$15K |
| D0270 |
|
1,781 |
1,742 |
$11K |
| D2394 |
|
40 |
39 |
$3K |
| D2331 |
|
50 |
33 |
$2K |
| D0190 |
|
149 |
149 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
19 |
15 |
$1K |
| D2330 |
|
41 |
25 |
$925.39 |
| D4910 |
|
27 |
27 |
$920.00 |