| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,558 |
3,934 |
$656K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
619 |
456 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
544 |
328 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
966 |
863 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,032 |
857 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
839 |
671 |
$3K |
| D0274 |
Bitewings - four radiographic images |
698 |
556 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
528 |
352 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
562 |
489 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
952 |
608 |
$744.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
46 |
$600.00 |
| D1206 |
Topical application of fluoride varnish |
23 |
13 |
$380.93 |
| D1110 |
Prophylaxis - adult |
102 |
94 |
$280.00 |
| D2331 |
|
20 |
14 |
$70.00 |
| D9992 |
|
101 |
88 |
$66.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$60.00 |