| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,712 |
5,479 |
$3.29M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,635 |
1,257 |
$29K |
| D1110 |
Prophylaxis - adult |
2,082 |
1,861 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
2,316 |
2,026 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
2,369 |
2,080 |
$12K |
| D1206 |
Topical application of fluoride varnish |
2,978 |
2,674 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
1,335 |
1,226 |
$10K |
| D0274 |
Bitewings - four radiographic images |
1,418 |
1,234 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
2,224 |
1,916 |
$6K |
| D1120 |
Prophylaxis - child |
990 |
895 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
480 |
323 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
848 |
822 |
$1K |
| D2335 |
|
24 |
12 |
$488.30 |
| D2940 |
|
23 |
12 |
$352.65 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$8.21 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
77 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |
| D5899 |
|
215 |
117 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
116 |
$0.00 |
| D1351 |
Sealant - per tooth |
63 |
26 |
$0.00 |