| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,212 |
2,832 |
$1.29M |
| D0120 |
Periodic oral evaluation - established patient |
704 |
678 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,905 |
1,836 |
$0.00 |
| D1351 |
Sealant - per tooth |
5,884 |
1,232 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
79 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,216 |
1,177 |
$0.00 |
| D1352 |
|
37 |
27 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
930 |
898 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
26 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,393 |
1,342 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
458 |
247 |
$0.00 |
| D2140 |
|
72 |
55 |
$0.00 |
| D1110 |
Prophylaxis - adult |
154 |
153 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
46 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
276 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
200 |
191 |
$0.00 |