| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
92,191 |
77,329 |
$12.90M |
| D0140 |
Limited oral evaluation - problem focused |
16,968 |
16,197 |
$378K |
| D0120 |
Periodic oral evaluation - established patient |
15,370 |
14,985 |
$376K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,147 |
4,720 |
$362K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,055 |
5,270 |
$342K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,281 |
10,782 |
$302K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,721 |
3,272 |
$216K |
| D0210 |
Intraoral - complete series of radiographic images |
6,191 |
5,922 |
$185K |
| D1110 |
Prophylaxis - adult |
4,726 |
4,565 |
$176K |
| D4341 |
|
6,191 |
3,765 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
15,675 |
14,895 |
$124K |
| D1120 |
Prophylaxis - child |
4,850 |
4,685 |
$99K |
| D0274 |
Bitewings - four radiographic images |
8,739 |
8,505 |
$92K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,814 |
1,324 |
$81K |
| D1206 |
Topical application of fluoride varnish |
6,577 |
6,375 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,671 |
4,489 |
$52K |
| D1999 |
|
3,498 |
3,005 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
419 |
377 |
$33K |
| D0272 |
Bitewings - two radiographic images |
3,131 |
3,009 |
$27K |
| D7220 |
|
319 |
253 |
$24K |
| D0270 |
|
2,845 |
2,771 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
332 |
224 |
$20K |
| D2140 |
|
581 |
384 |
$20K |
| D4910 |
|
282 |
273 |
$16K |
| D1351 |
Sealant - per tooth |
1,165 |
382 |
$15K |
| D2331 |
|
278 |
173 |
$13K |
| D2160 |
|
173 |
133 |
$9K |
| D0330 |
Panoramic radiographic image |
227 |
221 |
$6K |
| D7230 |
|
48 |
43 |
$6K |
| D2330 |
|
97 |
66 |
$5K |
| D9930 |
|
69 |
64 |
$3K |
| D0190 |
|
398 |
381 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
424 |
335 |
$862.38 |
| D9999 |
Unspecified adjunctive procedure, by report |
25 |
25 |
$634.34 |
| D1330 |
|
679 |
651 |
$207.52 |
| D0431 |
|
261 |
258 |
$0.00 |
| D9430 |
|
590 |
369 |
$0.00 |
| D0603 |
|
286 |
274 |
$0.00 |
| D0601 |
|
18 |
17 |
$0.00 |
| D0602 |
|
15 |
15 |
$0.00 |