| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,883 |
8,575 |
$865K |
| T1016 |
Case management, each 15 minutes |
727 |
512 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
760 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
3,791 |
3,714 |
$283.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
673 |
$236.00 |
| D1110 |
Prophylaxis - adult |
2,748 |
2,716 |
$165.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
34 |
34 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
38 |
38 |
$0.00 |
| D9996 |
|
371 |
337 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |