| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,095 |
1,623 |
$350K |
| D0120 |
Periodic oral evaluation - established patient |
3,088 |
2,310 |
$308K |
| D0140 |
Limited oral evaluation - problem focused |
944 |
907 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
330 |
324 |
$2K |
| D1120 |
Prophylaxis - child |
569 |
563 |
$1K |
| D0274 |
Bitewings - four radiographic images |
921 |
914 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,066 |
1,039 |
$785.25 |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
28 |
$728.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
283 |
280 |
$520.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
812 |
476 |
$197.75 |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
171 |
$153.75 |
| D0330 |
Panoramic radiographic image |
196 |
193 |
$35.25 |
| D0431 |
|
239 |
238 |
$0.00 |
| 59426 |
|
84 |
54 |
$0.00 |
| D2140 |
|
35 |
31 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
13 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
108 |
106 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
978 |
790 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
235 |
233 |
$0.00 |
| 82962 |
|
12 |
12 |
$0.00 |