| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,573 |
6,350 |
$1.09M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,453 |
1,033 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,558 |
912 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,601 |
1,276 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
1,400 |
1,191 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,504 |
1,162 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
1,713 |
1,321 |
$5K |
| D1110 |
Prophylaxis - adult |
677 |
565 |
$2K |
| D1120 |
Prophylaxis - child |
92 |
50 |
$2K |
| D1206 |
Topical application of fluoride varnish |
104 |
53 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
606 |
513 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
476 |
321 |
$810.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
128 |
117 |
$600.00 |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
329 |
$408.00 |
| D2330 |
|
19 |
12 |
$100.00 |
| D2331 |
|
15 |
12 |
$70.00 |
| D1330 |
|
15 |
15 |
$0.00 |