| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,070 |
966 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
158 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
260 |
$3K |
| D0274 |
Bitewings - four radiographic images |
122 |
78 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
152 |
134 |
$890.00 |
| D0140 |
Limited oral evaluation - problem focused |
290 |
251 |
$720.00 |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
223 |
$416.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
26 |
$341.00 |
| D0120 |
Periodic oral evaluation - established patient |
37 |
24 |
$140.00 |