| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
7,290 |
6,157 |
$1.19M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
728 |
612 |
$362.61 |
| D1330 |
|
2,153 |
2,013 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
731 |
689 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,735 |
1,648 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,412 |
628 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,079 |
1,973 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
82 |
78 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
43 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
849 |
723 |
$0.00 |
| D0602 |
|
40 |
35 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
517 |
356 |
$0.00 |
| D0603 |
|
374 |
326 |
$0.00 |
| D1351 |
Sealant - per tooth |
444 |
187 |
$0.00 |
| 90686 |
|
61 |
54 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
436 |
416 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
442 |
311 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,531 |
1,462 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,048 |
979 |
$0.00 |
| D0330 |
Panoramic radiographic image |
136 |
127 |
$0.00 |
| D1110 |
Prophylaxis - adult |
216 |
208 |
$0.00 |
| 81002 |
|
13 |
13 |
$0.00 |
| D1999 |
|
142 |
120 |
$0.00 |