| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,695 |
6,545 |
$1.23M |
| D0120 |
Periodic oral evaluation - established patient |
813 |
809 |
$23.72 |
| D1206 |
Topical application of fluoride varnish |
355 |
355 |
$20.59 |
| D0330 |
Panoramic radiographic image |
122 |
122 |
$0.00 |
| D1120 |
Prophylaxis - child |
231 |
231 |
$0.00 |
| D1110 |
Prophylaxis - adult |
647 |
630 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
408 |
405 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
134 |
$0.00 |
| D0270 |
|
55 |
55 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
624 |
599 |
$0.00 |
| D9110 |
|
29 |
29 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
243 |
234 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
153 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
116 |
116 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
70 |
65 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
168 |
168 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
37 |
30 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
146 |
$0.00 |
| D1330 |
|
31 |
25 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$0.00 |