| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
156,118 |
144,678 |
$55.62M |
| D0120 |
Periodic oral evaluation - established patient |
44,193 |
44,048 |
$1.16M |
| D1206 |
Topical application of fluoride varnish |
50,208 |
50,010 |
$890K |
| D1110 |
Prophylaxis - adult |
18,541 |
18,504 |
$810K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,096 |
10,167 |
$772K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,177 |
8,563 |
$569K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14,193 |
14,139 |
$530K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,344 |
6,177 |
$529K |
| D1120 |
Prophylaxis - child |
16,476 |
16,418 |
$384K |
| D0140 |
Limited oral evaluation - problem focused |
14,486 |
14,177 |
$381K |
| D1351 |
Sealant - per tooth |
16,690 |
6,109 |
$303K |
| D0274 |
Bitewings - four radiographic images |
25,526 |
25,438 |
$302K |
| D0220 |
Intraoral - periapical first radiographic image |
23,674 |
23,339 |
$228K |
| D0272 |
Bitewings - two radiographic images |
12,864 |
12,815 |
$126K |
| D1999 |
|
8,277 |
7,318 |
$105K |
| D0190 |
|
4,654 |
4,630 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,081 |
9,483 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,171 |
1,163 |
$41K |
| D4341 |
|
912 |
724 |
$28K |
| D9920 |
|
861 |
839 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
212 |
194 |
$18K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
103 |
85 |
$9K |
| D9992 |
|
603 |
583 |
$9K |
| D0330 |
Panoramic radiographic image |
165 |
164 |
$5K |
| D0270 |
|
46 |
45 |
$452.64 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$239.71 |