| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
3,137 |
2,560 |
$1.57M |
| D7140 |
Extraction, erupted tooth or exposed root |
1,122 |
481 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,604 |
1,491 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,565 |
1,460 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
352 |
247 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
506 |
487 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
70 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
560 |
536 |
$2K |
| D0330 |
Panoramic radiographic image |
105 |
92 |
$2K |
| D1206 |
Topical application of fluoride varnish |
592 |
570 |
$685.90 |
| D1110 |
Prophylaxis - adult |
362 |
349 |
$548.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
117 |
103 |
$256.43 |
| D0120 |
Periodic oral evaluation - established patient |
238 |
220 |
$240.25 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
136 |
$180.65 |
| D1120 |
Prophylaxis - child |
140 |
135 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
102 |
93 |
$0.00 |
| D4910 |
|
15 |
13 |
$0.00 |
| D5899 |
|
320 |
187 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
39 |
$0.00 |