| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
11,650 |
9,679 |
$1.97M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,379 |
1,104 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,792 |
2,737 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,065 |
823 |
$50K |
| D1110 |
Prophylaxis - adult |
702 |
691 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,238 |
1,207 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
778 |
756 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
270 |
248 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,471 |
1,444 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,030 |
1,962 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
472 |
459 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
902 |
885 |
$15K |
| D1999 |
|
851 |
699 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
237 |
119 |
$7K |
| D1120 |
Prophylaxis - child |
265 |
261 |
$6K |
| D2331 |
|
71 |
53 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
952 |
518 |
$2K |
| D4341 |
|
86 |
60 |
$2K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$1K |
| D1351 |
Sealant - per tooth |
47 |
26 |
$952.51 |
| D0270 |
|
76 |
75 |
$556.32 |
| D0602 |
|
70 |
69 |
$0.00 |
| D0601 |
|
288 |
284 |
$0.00 |
| D0603 |
|
162 |
160 |
$0.00 |