| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,269 |
1,085 |
$135K |
| D1110 |
Prophylaxis - adult |
214 |
210 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
242 |
241 |
$0.00 |
| D0330 |
Panoramic radiographic image |
162 |
161 |
$0.00 |
| D1120 |
Prophylaxis - child |
62 |
58 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
53 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
225 |
224 |
$0.00 |
| D1310 |
|
305 |
290 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
124 |
$0.00 |
| D1330 |
|
293 |
278 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
150 |
146 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
88 |
88 |
$0.00 |