| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,261 |
2,003 |
$553K |
| D0330 |
Panoramic radiographic image |
430 |
430 |
$111.00 |
| D0274 |
Bitewings - four radiographic images |
414 |
407 |
$84.00 |
| D1110 |
Prophylaxis - adult |
737 |
721 |
$72.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
352 |
$60.00 |
| D0120 |
Periodic oral evaluation - established patient |
360 |
348 |
$20.00 |
| D0140 |
Limited oral evaluation - problem focused |
146 |
143 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
272 |
265 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
79 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
80 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
147 |
147 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
100 |
96 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
45 |
$0.00 |