| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
55,455 |
50,121 |
$11.48M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,593 |
5,967 |
$485K |
| D0120 |
Periodic oral evaluation - established patient |
13,680 |
13,464 |
$338K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,021 |
4,531 |
$317K |
| D1206 |
Topical application of fluoride varnish |
16,759 |
16,415 |
$275K |
| D1120 |
Prophylaxis - child |
11,226 |
11,010 |
$254K |
| D1351 |
Sealant - per tooth |
10,004 |
4,172 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
21,078 |
20,528 |
$172K |
| D1110 |
Prophylaxis - adult |
3,870 |
3,814 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,433 |
4,333 |
$153K |
| D0274 |
Bitewings - four radiographic images |
10,167 |
10,012 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
4,613 |
4,475 |
$107K |
| D0330 |
Panoramic radiographic image |
3,173 |
3,135 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,754 |
17,153 |
$60K |
| D4341 |
|
1,456 |
1,158 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
991 |
723 |
$43K |
| D0272 |
Bitewings - two radiographic images |
4,235 |
4,180 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,129 |
2,113 |
$34K |
| D1999 |
|
1,997 |
1,891 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
349 |
310 |
$24K |
| D1354 |
|
5,786 |
2,083 |
$21K |
| D9992 |
|
846 |
830 |
$12K |
| D0270 |
|
729 |
722 |
$5K |
| D9995 |
|
304 |
300 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$420.00 |
| D0603 |
|
13 |
13 |
$0.00 |
| D0190 |
|
2,144 |
2,128 |
$0.00 |