| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
581 |
505 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
274 |
227 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
144 |
130 |
$2K |
| D0274 |
Bitewings - four radiographic images |
22 |
21 |
$396.00 |
| D0140 |
Limited oral evaluation - problem focused |
150 |
140 |
$120.00 |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
42 |
$20.00 |
| D9992 |
|
19 |
18 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$0.00 |