| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,234 |
1,028 |
$156K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
330 |
189 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
66 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
295 |
162 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
309 |
275 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
226 |
171 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
278 |
$960.00 |
| D0274 |
Bitewings - four radiographic images |
167 |
128 |
$816.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
102 |
$630.00 |
| D0140 |
Limited oral evaluation - problem focused |
167 |
143 |
$525.00 |
| D0220 |
Intraoral - periapical first radiographic image |
97 |
77 |
$108.00 |