| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
819 |
716 |
$136K |
| D1330 |
|
53 |
49 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
110 |
109 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
16 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
78 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
135 |
108 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
13 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$0.00 |
| D1110 |
Prophylaxis - adult |
146 |
145 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
159 |
158 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
103 |
102 |
$0.00 |
| D1999 |
|
168 |
150 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |