| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,847 |
1,657 |
$359K |
| D1120 |
Prophylaxis - child |
373 |
367 |
$270.00 |
| D1206 |
Topical application of fluoride varnish |
379 |
374 |
$126.00 |
| D0120 |
Periodic oral evaluation - established patient |
521 |
514 |
$80.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
199 |
192 |
$80.00 |
| D1110 |
Prophylaxis - adult |
762 |
751 |
$72.00 |
| D0274 |
Bitewings - four radiographic images |
122 |
119 |
$56.00 |
| D0272 |
Bitewings - two radiographic images |
186 |
184 |
$48.00 |
| D0220 |
Intraoral - periapical first radiographic image |
138 |
134 |
$0.00 |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
145 |
111 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
93 |
$0.00 |
| D5899 |
|
37 |
29 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$0.00 |