| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
5,771 |
5,053 |
$910K |
| D1110 |
Prophylaxis - adult |
1,484 |
1,463 |
$0.00 |
| D9110 |
|
384 |
378 |
$0.00 |
| D0330 |
Panoramic radiographic image |
566 |
558 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
440 |
377 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,312 |
1,294 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
749 |
735 |
$0.00 |
| D1120 |
Prophylaxis - child |
717 |
710 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
957 |
549 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,975 |
1,948 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
233 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,212 |
1,200 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
589 |
581 |
$0.00 |
| D2330 |
|
19 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
89 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
545 |
490 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
62 |
$0.00 |
| D5899 |
|
14 |
12 |
$0.00 |