| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,407 |
3,617 |
$621K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
303 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
449 |
272 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
717 |
582 |
$3K |
| D1110 |
Prophylaxis - adult |
1,239 |
1,078 |
$2K |
| D1120 |
Prophylaxis - child |
91 |
47 |
$2K |
| D0274 |
Bitewings - four radiographic images |
534 |
420 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
471 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
520 |
487 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
521 |
451 |
$975.00 |
| D1206 |
Topical application of fluoride varnish |
48 |
27 |
$900.38 |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
198 |
$585.00 |
| D0220 |
Intraoral - periapical first radiographic image |
565 |
402 |
$432.00 |
| D9992 |
|
205 |
151 |
$308.00 |
| D9310 |
|
72 |
56 |
$54.00 |
| D2330 |
|
18 |
12 |
$0.00 |