| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,222 |
5,890 |
$3.60M |
| D1110 |
Prophylaxis - adult |
2,542 |
2,349 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,418 |
951 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
2,882 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,727 |
853 |
$17K |
| D1206 |
Topical application of fluoride varnish |
3,333 |
3,069 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
1,822 |
1,652 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,646 |
1,494 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
502 |
463 |
$6K |
| D1120 |
Prophylaxis - child |
767 |
711 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
84 |
61 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,710 |
1,545 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
680 |
482 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
226 |
175 |
$3K |
| D0330 |
Panoramic radiographic image |
77 |
66 |
$2K |
| D0272 |
Bitewings - two radiographic images |
342 |
321 |
$2K |
| D2940 |
|
94 |
76 |
$1K |
| D5899 |
|
89 |
52 |
$0.00 |
| D2331 |
|
49 |
38 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
218 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
14 |
$0.00 |
| D1351 |
Sealant - per tooth |
92 |
16 |
$0.00 |
| D2394 |
|
12 |
12 |
$0.00 |