| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
176,826 |
154,896 |
$31.65M |
| D0120 |
Periodic oral evaluation - established patient |
43,454 |
41,652 |
$1.13M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,359 |
13,107 |
$1.05M |
| D0330 |
Panoramic radiographic image |
29,423 |
28,005 |
$965K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28,289 |
26,778 |
$939K |
| D0220 |
Intraoral - periapical first radiographic image |
80,926 |
75,540 |
$668K |
| D1110 |
Prophylaxis - adult |
15,255 |
14,592 |
$658K |
| D1206 |
Topical application of fluoride varnish |
34,786 |
33,492 |
$646K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,790 |
9,363 |
$618K |
| D0140 |
Limited oral evaluation - problem focused |
26,798 |
25,223 |
$617K |
| D1120 |
Prophylaxis - child |
20,998 |
19,906 |
$454K |
| D0274 |
Bitewings - four radiographic images |
39,031 |
37,409 |
$429K |
| D4341 |
|
9,126 |
5,965 |
$294K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,596 |
3,977 |
$257K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114,764 |
59,482 |
$241K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,125 |
2,459 |
$222K |
| D1999 |
|
19,001 |
16,316 |
$166K |
| D0272 |
Bitewings - two radiographic images |
12,392 |
11,670 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,358 |
6,599 |
$94K |
| D1351 |
Sealant - per tooth |
4,081 |
1,485 |
$81K |
| D0270 |
|
7,278 |
6,977 |
$44K |
| D2331 |
|
756 |
506 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
740 |
712 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
684 |
616 |
$17K |
| D2330 |
|
458 |
328 |
$17K |
| D4910 |
|
367 |
344 |
$16K |
| D2394 |
|
122 |
103 |
$7K |
| D2332 |
|
85 |
44 |
$3K |
| D4342 |
|
215 |
124 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
49 |
40 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
104 |
96 |
$2K |
| D2335 |
|
18 |
12 |
$944.68 |
| D2140 |
|
19 |
15 |
$774.99 |
| D1354 |
|
64 |
28 |
$180.00 |
| D0273 |
|
19 |
15 |
$167.46 |
| D0460 |
|
75 |
70 |
$24.25 |
| D9430 |
|
49 |
47 |
$0.00 |
| D0601 |
|
2,311 |
2,193 |
$0.00 |
| D0603 |
|
28,087 |
26,586 |
$0.00 |
| D0602 |
|
647 |
604 |
$0.00 |