| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,223 |
1,730 |
$653K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
60 |
57 |
$35.00 |
| D0272 |
Bitewings - two radiographic images |
155 |
155 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
325 |
324 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
55 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
253 |
$0.00 |
| D1330 |
|
515 |
513 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
114 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
328 |
246 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
165 |
164 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
25 |
$0.00 |
| 1036F |
|
37 |
34 |
$0.00 |
| D1110 |
Prophylaxis - adult |
402 |
401 |
$0.00 |
| D1120 |
Prophylaxis - child |
40 |
40 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
126 |
$0.00 |
| D9110 |
|
160 |
153 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
133 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$0.00 |