| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,087 |
2,960 |
$1.32M |
| D1110 |
Prophylaxis - adult |
414 |
410 |
$5K |
| D0274 |
Bitewings - four radiographic images |
383 |
381 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
675 |
674 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
294 |
$3K |
| D1120 |
Prophylaxis - child |
1,682 |
1,672 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,494 |
1,478 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
119 |
119 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
100 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,200 |
1,188 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,133 |
1,101 |
$1K |
| D0330 |
Panoramic radiographic image |
303 |
301 |
$462.00 |
| D1351 |
Sealant - per tooth |
1,694 |
333 |
$374.00 |
| D1206 |
Topical application of fluoride varnish |
1,745 |
1,735 |
$220.00 |
| D0272 |
Bitewings - two radiographic images |
790 |
786 |
$208.00 |
| D1354 |
|
654 |
186 |
$0.00 |
| D1999 |
|
310 |
287 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
16 |
$0.00 |
| D1310 |
|
186 |
186 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
16 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
24 |
$0.00 |
| D1330 |
|
187 |
187 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$0.00 |