| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
39,467 |
33,626 |
$7.59M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,370 |
4,265 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
3,454 |
3,400 |
$112K |
| D4341 |
|
3,457 |
2,234 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
11,201 |
10,671 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,702 |
1,414 |
$102K |
| D0330 |
Panoramic radiographic image |
3,437 |
3,352 |
$99K |
| D1110 |
Prophylaxis - adult |
2,165 |
2,132 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
3,137 |
3,056 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,003 |
3,967 |
$79K |
| D0274 |
Bitewings - four radiographic images |
6,128 |
6,014 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,755 |
7,076 |
$48K |
| D4910 |
|
707 |
697 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
491 |
385 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
465 |
452 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
317 |
176 |
$13K |
| D9992 |
|
657 |
642 |
$9K |
| D1999 |
|
482 |
450 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
54 |
$6K |
| D1354 |
|
958 |
151 |
$5K |
| D0270 |
|
626 |
611 |
$5K |
| D4342 |
|
59 |
40 |
$1K |
| D9920 |
|
15 |
15 |
$53.44 |
| D1330 |
|
421 |
384 |
$0.00 |