| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,310 |
2,057 |
$410K |
| D1110 |
Prophylaxis - adult |
634 |
544 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
207 |
134 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
529 |
410 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
105 |
$2K |
| D0274 |
Bitewings - four radiographic images |
292 |
227 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
531 |
458 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
504 |
$803.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
116 |
90 |
$630.00 |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
119 |
$570.00 |
| D0270 |
|
123 |
109 |
$96.00 |