| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,272 |
2,918 |
$563K |
| D1206 |
Topical application of fluoride varnish |
253 |
163 |
$5K |
| D1120 |
Prophylaxis - child |
120 |
110 |
$5K |
| D1110 |
Prophylaxis - adult |
1,090 |
970 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
752 |
608 |
$3K |
| D0274 |
Bitewings - four radiographic images |
393 |
320 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
692 |
633 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
844 |
766 |
$816.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
51 |
$750.00 |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
158 |
$605.00 |
| D0270 |
|
310 |
293 |
$168.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
24 |
$90.00 |
| D9992 |
|
62 |
54 |
$88.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
232 |
168 |
$45.00 |
| D1330 |
|
128 |
128 |
$0.00 |