| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,076 |
21,424 |
$1.58M |
| D1120 |
Prophylaxis - child |
13,481 |
12,686 |
$399K |
| 00003 |
Internal/system code - not a standard HCPCS code |
3,068 |
1,420 |
$363K |
| D0120 |
Periodic oral evaluation - established patient |
17,312 |
16,374 |
$231K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,577 |
12,785 |
$223K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72,628 |
15,148 |
$183K |
| D0274 |
Bitewings - four radiographic images |
11,227 |
10,622 |
$167K |
| D1351 |
Sealant - per tooth |
7,809 |
2,871 |
$153K |
| D0220 |
Intraoral - periapical first radiographic image |
18,125 |
16,480 |
$146K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,756 |
1,489 |
$66K |
| D1310 |
|
15,160 |
14,216 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
963 |
821 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
557 |
525 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
836 |
769 |
$16K |
| D9999 |
Unspecified adjunctive procedure, by report |
379 |
284 |
$12K |
| D0603 |
|
2,759 |
2,758 |
$10K |
| D9430 |
|
428 |
411 |
$8K |
| D0170 |
|
168 |
126 |
$7K |
| D1352 |
|
424 |
302 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
34 |
34 |
$2K |
| D0272 |
Bitewings - two radiographic images |
331 |
271 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$798.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
12 |
$225.00 |
| D1320 |
|
60 |
60 |
$142.50 |
| D0270 |
|
12 |
12 |
$60.00 |
| D9995 |
|
209 |
207 |
$0.00 |
| D1330 |
|
11,572 |
10,827 |
$0.00 |