| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,208 |
1,809 |
$388K |
| D5899 |
|
137 |
78 |
$0.00 |
| D9995 |
|
70 |
67 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
291 |
291 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
291 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
74 |
67 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
224 |
220 |
$0.00 |
| D1110 |
Prophylaxis - adult |
399 |
399 |
$0.00 |
| D0330 |
Panoramic radiographic image |
361 |
360 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
421 |
420 |
$0.00 |