| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
64,036 |
54,636 |
$7.77M |
| D1110 |
Prophylaxis - adult |
8,244 |
7,879 |
$142.42 |
| D0220 |
Intraoral - periapical first radiographic image |
7,321 |
6,757 |
$93.84 |
| D0140 |
Limited oral evaluation - problem focused |
7,720 |
7,119 |
$37.21 |
| D0274 |
Bitewings - four radiographic images |
7,302 |
6,976 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,569 |
1,171 |
$0.00 |
| D0191 |
|
59 |
57 |
$0.00 |
| D0330 |
Panoramic radiographic image |
2,662 |
2,542 |
$0.00 |
| D1120 |
Prophylaxis - child |
11,970 |
11,650 |
$0.00 |
| D0190 |
|
157 |
153 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
560 |
495 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
52 |
$0.00 |
| D9110 |
|
44 |
39 |
$0.00 |
| D2940 |
|
54 |
42 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
9,733 |
9,333 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,171 |
1,139 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
6,170 |
6,012 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,668 |
1,930 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,960 |
1,200 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,888 |
1,711 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
5,804 |
5,673 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,795 |
1,671 |
$0.00 |
| D0601 |
|
195 |
193 |
$0.00 |
| D1351 |
Sealant - per tooth |
963 |
258 |
$0.00 |
| D0603 |
|
125 |
122 |
$0.00 |
| D0602 |
|
186 |
179 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
311 |
159 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
24 |
$0.00 |
| D5899 |
|
373 |
211 |
$0.00 |