| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,851 |
8,490 |
$1.64M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,086 |
639 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
2,555 |
2,019 |
$12K |
| D0274 |
Bitewings - four radiographic images |
1,959 |
1,509 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
3,720 |
3,116 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
811 |
630 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
369 |
246 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
3,334 |
2,792 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
487 |
421 |
$3K |
| D2940 |
|
575 |
327 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
263 |
160 |
$248.00 |
| D1110 |
Prophylaxis - adult |
54 |
53 |
$160.00 |
| D9992 |
|
153 |
140 |
$140.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
35 |
26 |
$0.00 |
| D2331 |
|
18 |
13 |
$0.00 |