| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
17,040 |
15,142 |
$3.50M |
| D0220 |
Intraoral - periapical first radiographic image |
2,316 |
2,283 |
$0.00 |
| D1110 |
Prophylaxis - adult |
5,284 |
5,271 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,434 |
1,110 |
$0.00 |
| D0330 |
Panoramic radiographic image |
623 |
623 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
2,520 |
2,518 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,123 |
1,119 |
$0.00 |
| D2332 |
|
228 |
180 |
$0.00 |
| D9110 |
|
53 |
53 |
$0.00 |
| D0270 |
|
126 |
126 |
$0.00 |
| D2394 |
|
46 |
44 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
131 |
86 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,326 |
1,325 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,005 |
2,000 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,565 |
1,507 |
$0.00 |
| D5899 |
|
647 |
434 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,808 |
1,363 |
$0.00 |
| D2331 |
|
529 |
401 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
625 |
623 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
5,225 |
5,211 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
792 |
643 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,164 |
676 |
$0.00 |
| D2330 |
|
231 |
171 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
646 |
532 |
$0.00 |
| D1330 |
|
678 |
674 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
152 |
152 |
$0.00 |
| D0603 |
|
57 |
57 |
$0.00 |
| D2335 |
|
196 |
146 |
$0.00 |
| D1351 |
Sealant - per tooth |
332 |
75 |
$0.00 |