| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,137 |
3,048 |
$402K |
| D9110 |
|
97 |
97 |
$0.00 |
| D1120 |
Prophylaxis - child |
773 |
767 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
950 |
943 |
$0.00 |
| D0330 |
Panoramic radiographic image |
494 |
492 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
224 |
224 |
$0.00 |
| D1110 |
Prophylaxis - adult |
864 |
854 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
153 |
118 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
282 |
280 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
650 |
646 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
283 |
281 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,265 |
1,254 |
$0.00 |
| D1351 |
Sealant - per tooth |
337 |
70 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
505 |
503 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
37 |
$0.00 |