| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
10,425 |
8,456 |
$1.77M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,082 |
602 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
816 |
548 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,787 |
1,411 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
2,402 |
1,931 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
3,552 |
3,036 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
730 |
559 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
567 |
474 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,007 |
2,615 |
$3K |
| D2331 |
|
108 |
76 |
$746.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
607 |
339 |
$213.00 |
| D9992 |
|
133 |
123 |
$160.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
26 |
$16.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
86 |
59 |
$0.00 |
| D1110 |
Prophylaxis - adult |
32 |
31 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
16 |
12 |
$0.00 |