| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
31,499 |
25,425 |
$8.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,359 |
3,178 |
$327K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,463 |
2,879 |
$263K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,186 |
4,867 |
$204K |
| D1206 |
Topical application of fluoride varnish |
8,928 |
8,511 |
$181K |
| D0330 |
Panoramic radiographic image |
3,953 |
3,731 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
4,524 |
4,342 |
$131K |
| D4341 |
|
3,114 |
2,192 |
$127K |
| D1120 |
Prophylaxis - child |
4,519 |
4,300 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
10,381 |
9,704 |
$100K |
| D0274 |
Bitewings - four radiographic images |
5,817 |
5,510 |
$74K |
| D1110 |
Prophylaxis - adult |
1,260 |
1,233 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,915 |
1,786 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,068 |
8,609 |
$49K |
| D1351 |
Sealant - per tooth |
1,299 |
434 |
$26K |
| D4342 |
|
618 |
381 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,409 |
1,344 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
55 |
$7K |
| D9110 |
|
88 |
71 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
66 |
$5K |
| D0270 |
|
54 |
52 |
$299.76 |
| D0603 |
|
57 |
53 |
$0.00 |