| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,577 |
3,350 |
$565K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
135 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
1,189 |
742 |
$6K |
| D0274 |
Bitewings - four radiographic images |
899 |
543 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
91 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
265 |
181 |
$2K |
| D1120 |
Prophylaxis - child |
125 |
57 |
$2K |
| D1110 |
Prophylaxis - adult |
463 |
308 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
839 |
638 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
54 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,047 |
773 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
88 |
$270.00 |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
126 |
$165.00 |
| D0602 |
|
311 |
255 |
$0.00 |
| D0603 |
|
226 |
207 |
$0.00 |
| D0024 |
|
155 |
109 |
$0.00 |
| D0601 |
|
19 |
15 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
24 |
$0.00 |
| DS001 |
|
178 |
127 |
$0.00 |
| D2394 |
|
37 |
29 |
$0.00 |