| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,678 |
5,633 |
$1.88M |
| D1120 |
Prophylaxis - child |
1,376 |
1,333 |
$0.00 |
| D0190 |
|
2,871 |
2,493 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
497 |
475 |
$0.00 |
| D1110 |
Prophylaxis - adult |
214 |
208 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,642 |
1,538 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
117 |
80 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
257 |
253 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
576 |
507 |
$0.00 |
| D0601 |
|
948 |
806 |
$0.00 |
| D0603 |
|
2,360 |
2,135 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,895 |
2,643 |
$0.00 |
| D0602 |
|
387 |
325 |
$0.00 |
| D1330 |
|
2,934 |
2,522 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
386 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
212 |
209 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,086 |
885 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
792 |
773 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
86 |
$0.00 |
| D1351 |
Sealant - per tooth |
65 |
19 |
$0.00 |