| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,439 |
2,035 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
997 |
690 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
624 |
301 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
878 |
710 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
92 |
40 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
360 |
186 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
260 |
242 |
$0.00 |
| D0240 |
|
45 |
27 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
138 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
208 |
132 |
$0.00 |
| D1351 |
Sealant - per tooth |
477 |
60 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
28 |
$0.00 |
| D1354 |
|
119 |
32 |
$0.00 |
| D0270 |
|
130 |
66 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
665 |
500 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,014 |
657 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
322 |
177 |
$0.00 |
| D1110 |
Prophylaxis - adult |
258 |
141 |
$0.00 |
| D1999 |
|
296 |
229 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
42 |
$0.00 |
| D4910 |
|
18 |
18 |
$0.00 |