| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,165 |
5,693 |
$3.57M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,415 |
995 |
$28K |
| D1110 |
Prophylaxis - adult |
2,334 |
2,185 |
$23K |
| D1206 |
Topical application of fluoride varnish |
3,281 |
3,067 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
2,796 |
2,618 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
768 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,632 |
1,523 |
$10K |
| D1120 |
Prophylaxis - child |
1,261 |
1,176 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
1,048 |
962 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
640 |
299 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
295 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
744 |
526 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
813 |
754 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,299 |
$5K |
| D2394 |
|
13 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
836 |
162 |
$0.00 |
| D5899 |
|
226 |
144 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$0.00 |
| D2330 |
|
35 |
24 |
$0.00 |
| D2331 |
|
33 |
26 |
$0.00 |
| D2335 |
|
14 |
12 |
$0.00 |