| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
12,338 |
10,933 |
$2.32M |
| D7140 |
Extraction, erupted tooth or exposed root |
797 |
455 |
$130.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,250 |
976 |
$60.00 |
| D0274 |
Bitewings - four radiographic images |
1,900 |
1,894 |
$56.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,975 |
1,934 |
$40.00 |
| D0330 |
Panoramic radiographic image |
1,377 |
1,371 |
$37.00 |
| D1110 |
Prophylaxis - adult |
2,162 |
2,149 |
$36.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,379 |
1,377 |
$30.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
496 |
465 |
$24.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,331 |
1,313 |
$20.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,673 |
2,661 |
$20.00 |
| D0272 |
Bitewings - two radiographic images |
818 |
816 |
$16.00 |
| D0270 |
|
520 |
514 |
$8.00 |
| D1330 |
|
2,210 |
2,197 |
$0.00 |
| D0603 |
|
129 |
129 |
$0.00 |
| D2331 |
|
21 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,195 |
2,188 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
220 |
219 |
$0.00 |
| D2335 |
|
34 |
27 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
407 |
362 |
$0.00 |
| D1310 |
|
148 |
148 |
$0.00 |
| D1351 |
Sealant - per tooth |
379 |
115 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,450 |
1,446 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
920 |
728 |
$0.00 |
| D9110 |
|
302 |
299 |
$0.00 |
| D9986 |
|
32 |
32 |
$0.00 |
| D0190 |
|
88 |
88 |
$0.00 |
| D2332 |
|
14 |
12 |
$0.00 |
| D1999 |
|
18 |
15 |
$0.00 |