| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
115,875 |
107,100 |
$21.18M |
| D0120 |
Periodic oral evaluation - established patient |
37,296 |
36,876 |
$971K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,129 |
9,374 |
$743K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,958 |
9,493 |
$631K |
| D1120 |
Prophylaxis - child |
25,785 |
25,473 |
$600K |
| D1206 |
Topical application of fluoride varnish |
24,144 |
23,782 |
$454K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,412 |
485 |
$437K |
| D0330 |
Panoramic radiographic image |
10,212 |
10,072 |
$383K |
| D0140 |
Limited oral evaluation - problem focused |
13,726 |
13,328 |
$310K |
| D1110 |
Prophylaxis - adult |
6,311 |
6,250 |
$247K |
| D1351 |
Sealant - per tooth |
8,863 |
3,246 |
$191K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,089 |
12,030 |
$179K |
| D9999 |
Unspecified adjunctive procedure, by report |
6,467 |
6,416 |
$169K |
| D0274 |
Bitewings - four radiographic images |
12,003 |
11,857 |
$162K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,074 |
4,007 |
$150K |
| D0272 |
Bitewings - two radiographic images |
14,947 |
14,740 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,121 |
3,800 |
$90K |
| D4341 |
|
2,056 |
1,337 |
$74K |
| D0190 |
|
5,796 |
5,776 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,189 |
763 |
$58K |
| D9995 |
|
5,779 |
5,735 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
5,622 |
5,496 |
$51K |
| D4910 |
|
591 |
582 |
$36K |
| D2929 |
|
75 |
24 |
$22K |
| D4342 |
|
1,111 |
579 |
$19K |
| D0240 |
|
1,372 |
937 |
$15K |
| D9248 |
|
163 |
152 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
110 |
$9K |
| D9992 |
|
582 |
554 |
$8K |
| D1354 |
|
1,812 |
635 |
$7K |
| D4346 |
|
105 |
101 |
$6K |
| D1330 |
|
3,524 |
3,459 |
$5K |
| D2331 |
|
30 |
16 |
$4K |
| D2330 |
|
42 |
27 |
$2K |
| D9920 |
|
30 |
29 |
$720.94 |
| D0160 |
|
15 |
14 |
$604.52 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
41 |
$111.72 |
| D0603 |
|
858 |
854 |
$0.00 |
| D0602 |
|
372 |
369 |
$0.00 |
| D0601 |
|
23 |
22 |
$0.00 |