| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
11,075 |
9,091 |
$5.53M |
| D7140 |
Extraction, erupted tooth or exposed root |
3,375 |
1,320 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
2,389 |
2,251 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,663 |
1,228 |
$32K |
| D1110 |
Prophylaxis - adult |
3,341 |
3,180 |
$31K |
| D1206 |
Topical application of fluoride varnish |
4,725 |
4,482 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
2,405 |
2,215 |
$20K |
| D1351 |
Sealant - per tooth |
4,544 |
694 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,499 |
1,015 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
3,102 |
2,936 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,182 |
2,050 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,874 |
1,780 |
$12K |
| D1120 |
Prophylaxis - child |
1,218 |
1,153 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,333 |
2,158 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
303 |
254 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
24 |
$2K |
| D2335 |
|
75 |
56 |
$2K |
| D2331 |
|
94 |
68 |
$1K |
| D0330 |
Panoramic radiographic image |
108 |
92 |
$1K |
| D0270 |
|
298 |
281 |
$786.21 |
| D2330 |
|
184 |
118 |
$711.85 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
12 |
$357.00 |
| D5899 |
|
610 |
311 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
51 |
45 |
$0.00 |
| D2332 |
|
46 |
38 |
$0.00 |