| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
604 |
539 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
255 |
242 |
$810.00 |
| D0210 |
Intraoral - complete series of radiographic images |
199 |
196 |
$605.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
30 |
$385.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
41 |
$225.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
16 |
$135.00 |
| D0140 |
Limited oral evaluation - problem focused |
53 |
51 |
$50.00 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
40 |
$24.00 |