| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,452 |
8,127 |
$1.67M |
| D1110 |
Prophylaxis - adult |
3,410 |
3,082 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,867 |
1,607 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,472 |
1,268 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
870 |
800 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
1,685 |
1,533 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
670 |
606 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
2,008 |
1,832 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,418 |
881 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
40 |
$900.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
221 |
187 |
$720.00 |
| D2160 |
|
85 |
68 |
$560.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
40 |
$360.10 |
| D0270 |
|
369 |
340 |
$336.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$200.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
65 |
$16.00 |
| D1330 |
|
731 |
727 |
$0.00 |
| D0602 |
|
44 |
44 |
$0.00 |
| D0603 |
|
43 |
43 |
$0.00 |