| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,370 |
2,141 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
924 |
912 |
$0.00 |
| D1120 |
Prophylaxis - child |
450 |
450 |
$0.00 |
| D1354 |
|
136 |
39 |
$0.00 |
| D0270 |
|
124 |
122 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$0.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$0.00 |
| D1999 |
|
50 |
48 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
632 |
626 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
371 |
367 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
661 |
661 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
414 |
411 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
49 |
49 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$0.00 |