| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,770 |
5,123 |
$1.89M |
| D0120 |
Periodic oral evaluation - established patient |
1,368 |
1,317 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
217 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,272 |
1,210 |
$14K |
| D1120 |
Prophylaxis - child |
963 |
913 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
751 |
679 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
97 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
506 |
$4K |
| D1110 |
Prophylaxis - adult |
109 |
105 |
$3K |
| D0274 |
Bitewings - four radiographic images |
170 |
165 |
$2K |
| D1351 |
Sealant - per tooth |
121 |
39 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
32 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
568 |
246 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$723.80 |
| D1354 |
|
2,016 |
240 |
$621.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
102 |
$539.76 |
| D0272 |
Bitewings - two radiographic images |
28 |
27 |
$267.54 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$255.30 |
| D1330 |
|
949 |
894 |
$0.00 |
| D0191 |
|
186 |
183 |
$0.00 |
| D0190 |
|
468 |
441 |
$0.00 |