| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,718 |
3,286 |
$461K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
476 |
414 |
$105.00 |
| 3008F |
|
780 |
717 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
62 |
56 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
117 |
117 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
67 |
67 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
246 |
245 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |
| 99406 |
|
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
208 |
206 |
$0.00 |
| D1120 |
Prophylaxis - child |
29 |
29 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
16 |
$0.00 |