| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,779 |
1,649 |
$188K |
| D0120 |
Periodic oral evaluation - established patient |
178 |
178 |
$0.00 |
| D1330 |
|
243 |
243 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
112 |
112 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
267 |
$0.00 |
| D1310 |
|
238 |
238 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
186 |
186 |
$0.00 |
| D0330 |
Panoramic radiographic image |
152 |
152 |
$0.00 |
| D1110 |
Prophylaxis - adult |
406 |
406 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$0.00 |
| D1999 |
|
163 |
156 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
27 |
$0.00 |
| D1120 |
Prophylaxis - child |
102 |
102 |
$0.00 |