| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,402 |
8,068 |
$1.64M |
| D0274 |
Bitewings - four radiographic images |
2,384 |
1,864 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,089 |
686 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
2,632 |
2,089 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
2,872 |
2,460 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
365 |
$6K |
| D1120 |
Prophylaxis - child |
123 |
123 |
$5K |
| D1206 |
Topical application of fluoride varnish |
131 |
131 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
918 |
749 |
$4K |
| D1351 |
Sealant - per tooth |
166 |
50 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,516 |
2,161 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
574 |
527 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
490 |
219 |
$843.00 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$520.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
483 |
256 |
$222.00 |
| D9992 |
|
200 |
187 |
$180.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$126.00 |
| D2331 |
|
36 |
28 |
$44.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
14 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
105 |
83 |
$0.00 |