| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,713 |
1,601 |
$748K |
| D1351 |
Sealant - per tooth |
230 |
167 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
331 |
329 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
593 |
585 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
434 |
427 |
$0.00 |
| D1310 |
|
662 |
661 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
30 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
67 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
536 |
530 |
$0.00 |
| D1330 |
|
694 |
693 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
74 |
73 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
930 |
918 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
273 |
242 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
69 |
$0.00 |
| D1120 |
Prophylaxis - child |
976 |
966 |
$0.00 |
| D1110 |
Prophylaxis - adult |
139 |
136 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
329 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
160 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
158 |
156 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
133 |
$0.00 |
| D0330 |
Panoramic radiographic image |
268 |
261 |
$0.00 |
| D1354 |
|
36 |
32 |
$0.00 |