| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,332 |
1,139 |
$113K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
52 |
49 |
$539.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
125 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
16 |
16 |
$0.00 |
| D0330 |
Panoramic radiographic image |
132 |
130 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
61 |
$0.00 |
| D1110 |
Prophylaxis - adult |
107 |
107 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
88 |
88 |
$0.00 |