| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,153 |
5,125 |
$381K |
| D1110 |
Prophylaxis - adult |
2,097 |
1,723 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
282 |
152 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,786 |
1,446 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
1,435 |
1,135 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
227 |
136 |
$9K |
| D1206 |
Topical application of fluoride varnish |
1,308 |
985 |
$9K |
| D1120 |
Prophylaxis - child |
781 |
555 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,525 |
1,280 |
$6K |
| D0330 |
Panoramic radiographic image |
207 |
166 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,084 |
582 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,100 |
1,690 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
353 |
$1K |
| D0272 |
Bitewings - two radiographic images |
104 |
68 |
$304.50 |