| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
18,303 |
14,496 |
$3.38M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,463 |
4,018 |
$129K |
| D0210 |
Intraoral - complete series of radiographic images |
2,779 |
2,504 |
$90K |
| D4341 |
|
3,155 |
1,953 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,364 |
1,081 |
$76K |
| D1110 |
Prophylaxis - adult |
1,545 |
1,333 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,957 |
1,940 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,309 |
2,136 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,722 |
3,470 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
896 |
690 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
4,476 |
4,144 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,476 |
1,424 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,936 |
1,873 |
$7K |
| D1999 |
|
474 |
394 |
$7K |
| D0190 |
|
615 |
583 |
$6K |
| D1120 |
Prophylaxis - child |
308 |
264 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
68 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
84 |
$4K |
| D9992 |
|
302 |
284 |
$4K |
| D0270 |
|
713 |
663 |
$4K |
| D4342 |
|
135 |
79 |
$2K |
| D0272 |
Bitewings - two radiographic images |
27 |
27 |
$267.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
19 |
17 |
$215.02 |
| D1330 |
|
23 |
21 |
$0.00 |