| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
513 |
443 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
84 |
48 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
79 |
$2K |
| D0274 |
Bitewings - four radiographic images |
168 |
119 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
190 |
133 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
69 |
$450.00 |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
70 |
$330.00 |
| D0140 |
Limited oral evaluation - problem focused |
68 |
55 |
$225.00 |
| D0220 |
Intraoral - periapical first radiographic image |
83 |
52 |
$84.00 |