| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,095 |
1,309 |
$225K |
| D0999 |
Unspecified diagnostic procedure, by report |
300 |
291 |
$41K |
| 81002 |
|
660 |
387 |
$3.41 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
48 |
37 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
82 |
81 |
$0.00 |
| 81025 |
|
116 |
108 |
$0.00 |
| D1120 |
Prophylaxis - child |
96 |
96 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$0.00 |
| 0502F |
|
18 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
67 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
531 |
370 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
112 |
112 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
78 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |