| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
13,305 |
10,837 |
$2.15M |
| D0120 |
Periodic oral evaluation - established patient |
3,933 |
3,839 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,431 |
1,102 |
$81K |
| D1110 |
Prophylaxis - adult |
2,108 |
2,060 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,474 |
1,411 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,813 |
1,763 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
442 |
428 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
572 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
266 |
$12K |
| D1999 |
|
847 |
715 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,215 |
1,165 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
461 |
460 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
44 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
38 |
$2K |
| D4910 |
|
47 |
47 |
$2K |
| D0270 |
|
58 |
54 |
$471.84 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$298.74 |
| D0601 |
|
539 |
533 |
$0.00 |
| D0603 |
|
89 |
89 |
$0.00 |
| D0602 |
|
60 |
59 |
$0.00 |