| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,308 |
6,609 |
$3.19M |
| D1206 |
Topical application of fluoride varnish |
3,172 |
3,064 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,033 |
1,031 |
$19K |
| D1351 |
Sealant - per tooth |
2,448 |
576 |
$17K |
| D1110 |
Prophylaxis - adult |
411 |
404 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
503 |
470 |
$9K |
| D1120 |
Prophylaxis - child |
331 |
324 |
$6K |
| D1999 |
|
383 |
332 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
698 |
671 |
$5K |
| D0274 |
Bitewings - four radiographic images |
189 |
189 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
29 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
43 |
$1K |
| D1354 |
|
254 |
58 |
$820.20 |
| D1330 |
|
91 |
86 |
$470.00 |
| D0272 |
Bitewings - two radiographic images |
44 |
43 |
$349.86 |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
39 |
$133.68 |
| D0190 |
|
55 |
55 |
$0.00 |