| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
9,135 |
7,101 |
$191K |
| D0274 |
Bitewings - four radiographic images |
834 |
725 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
292 |
256 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,825 |
2,371 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
4,098 |
3,446 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
107 |
72 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
474 |
334 |
$0.00 |
| D1354 |
|
576 |
107 |
$0.00 |
| D1110 |
Prophylaxis - adult |
357 |
274 |
$0.00 |
| D0330 |
Panoramic radiographic image |
28 |
25 |
$0.00 |
| D0270 |
|
57 |
57 |
$0.00 |
| D0190 |
|
19 |
19 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,570 |
2,226 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
332 |
227 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,228 |
1,020 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,741 |
3,141 |
$0.00 |
| D1351 |
Sealant - per tooth |
1,332 |
337 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
1,888 |
1,610 |
$0.00 |
| D1330 |
|
914 |
720 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,624 |
2,228 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
311 |
189 |
$0.00 |
| D1310 |
|
542 |
445 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,061 |
855 |
$0.00 |