| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
22,015 |
16,065 |
$6.81M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
856 |
567 |
$3K |
| D1110 |
Prophylaxis - adult |
2,898 |
2,676 |
$1K |
| D0330 |
Panoramic radiographic image |
848 |
783 |
$480.48 |
| D0210 |
Intraoral - complete series of radiographic images |
389 |
359 |
$385.00 |
| D0140 |
Limited oral evaluation - problem focused |
4,816 |
3,936 |
$160.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,527 |
1,417 |
$85.80 |
| D0220 |
Intraoral - periapical first radiographic image |
1,694 |
1,582 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
177 |
120 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,017 |
947 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
123 |
80 |
$0.00 |
| D0270 |
|
13 |
13 |
$0.00 |
| D2140 |
|
36 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
924 |
858 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
298 |
160 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
63 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
150 |
135 |
$0.00 |
| D2331 |
|
23 |
12 |
$0.00 |