| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,094 |
6,340 |
$722K |
| D1206 |
Topical application of fluoride varnish |
3,390 |
3,119 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,428 |
1,239 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,037 |
873 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
226 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,457 |
2,183 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,188 |
1,107 |
$0.00 |
| D0603 |
|
981 |
755 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,528 |
412 |
$0.00 |
| D0240 |
|
293 |
218 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,574 |
1,314 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
183 |
169 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
272 |
260 |
$0.00 |
| D1330 |
|
16 |
16 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
983 |
891 |
$0.00 |
| D1120 |
Prophylaxis - child |
3,157 |
2,814 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,763 |
1,590 |
$0.00 |
| D1999 |
|
1,377 |
1,197 |
$0.00 |
| D0190 |
|
147 |
138 |
$0.00 |
| D1110 |
Prophylaxis - adult |
697 |
639 |
$0.00 |
| D9993 |
|
23 |
14 |
$0.00 |
| D1354 |
|
639 |
224 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
138 |
127 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
160 |
$0.00 |
| D0270 |
|
41 |
41 |
$0.00 |