| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,660 |
1,501 |
$442K |
| D0220 |
Intraoral - periapical first radiographic image |
450 |
439 |
$0.00 |
| D1110 |
Prophylaxis - adult |
429 |
428 |
$0.00 |
| D1120 |
Prophylaxis - child |
196 |
196 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
121 |
120 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
97 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
56 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
111 |
110 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
238 |
234 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
408 |
407 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
15 |
$0.00 |
| D1330 |
|
18 |
18 |
$0.00 |