| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,059 |
5,678 |
$738K |
| D0120 |
Periodic oral evaluation - established patient |
1,777 |
1,763 |
$20.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
595 |
591 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
682 |
680 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
649 |
645 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
326 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
367 |
364 |
$0.00 |
| D0603 |
|
371 |
365 |
$0.00 |
| D0602 |
|
137 |
134 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
274 |
$0.00 |
| D1351 |
Sealant - per tooth |
445 |
75 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
53 |
48 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
33 |
$0.00 |
| D9110 |
|
390 |
384 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,403 |
1,393 |
$0.00 |
| D0330 |
Panoramic radiographic image |
911 |
904 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,086 |
1,079 |
$0.00 |
| D1120 |
Prophylaxis - child |
875 |
871 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
136 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$0.00 |
| D1999 |
|
855 |
827 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
655 |
640 |
$0.00 |
| D2332 |
|
30 |
25 |
$0.00 |