| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,457 |
6,691 |
$955K |
| D1120 |
Prophylaxis - child |
2,054 |
1,759 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
63 |
$0.00 |
| D1110 |
Prophylaxis - adult |
377 |
282 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
158 |
115 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
377 |
313 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,659 |
1,428 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,701 |
1,432 |
$0.00 |
| D0603 |
|
191 |
158 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
292 |
258 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
463 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
206 |
164 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
138 |
$0.00 |
| D0602 |
|
197 |
173 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
13 |
$0.00 |