| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
242 |
224 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
88 |
88 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
46 |
46 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
73 |
$0.00 |
| D0603 |
|
35 |
35 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
87 |
87 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |
| D1310 |
|
16 |
16 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$0.00 |