| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,328 |
3,878 |
$340K |
| D0330 |
Panoramic radiographic image |
4,274 |
3,386 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,687 |
1,002 |
$106K |
| D1110 |
Prophylaxis - adult |
2,935 |
2,309 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,309 |
3,169 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,087 |
1,867 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
1,741 |
1,503 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,275 |
1,239 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
345 |
225 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,828 |
2,754 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,630 |
1,058 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
251 |
160 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
130 |
97 |
$12K |
| D1206 |
Topical application of fluoride varnish |
542 |
537 |
$11K |
| D1120 |
Prophylaxis - child |
140 |
139 |
$3K |
| D4342 |
|
28 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
80 |
$920.84 |
| D0180 |
|
31 |
25 |
$613.60 |