| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
6,064 |
5,361 |
$1.05M |
| D0274 |
Bitewings - four radiographic images |
261 |
249 |
$0.00 |
| D1120 |
Prophylaxis - child |
505 |
485 |
$0.00 |
| D1110 |
Prophylaxis - adult |
525 |
511 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
125 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
320 |
$0.00 |
| D1330 |
|
1,275 |
1,257 |
$0.00 |
| D0603 |
|
520 |
510 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
857 |
831 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
951 |
922 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
249 |
237 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
82 |
81 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
102 |
$0.00 |
| D0602 |
|
40 |
40 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
77 |
$0.00 |