| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
546 |
463 |
$92K |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
89 |
$0.00 |
| D1110 |
Prophylaxis - adult |
122 |
122 |
$0.00 |
| D1330 |
|
80 |
80 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
32 |
31 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
75 |
75 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
49 |
49 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$0.00 |