| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,967 |
2,790 |
$378K |
| D0330 |
Panoramic radiographic image |
738 |
722 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
922 |
898 |
$0.00 |
| D1110 |
Prophylaxis - adult |
750 |
739 |
$0.00 |
| D1120 |
Prophylaxis - child |
460 |
456 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
417 |
301 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
912 |
897 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
279 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
315 |
310 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
476 |
468 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
425 |
416 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
345 |
345 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
622 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
897 |
889 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |