| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,293 |
5,800 |
$2.89M |
| D0120 |
Periodic oral evaluation - established patient |
870 |
860 |
$24K |
| D1110 |
Prophylaxis - adult |
681 |
672 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,411 |
1,389 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
358 |
234 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
174 |
141 |
$13K |
| D0274 |
Bitewings - four radiographic images |
541 |
530 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
280 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
558 |
534 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
41 |
$2K |
| D1999 |
|
203 |
169 |
$2K |
| D4341 |
|
26 |
14 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
46 |
$1K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$851.46 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$837.20 |
| D9995 |
|
28 |
28 |
$160.00 |
| D0270 |
|
25 |
25 |
$126.24 |
| D0191 |
|
13 |
13 |
$0.00 |