| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,484 |
1,424 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
535 |
534 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
115 |
114 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
322 |
322 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
356 |
355 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
112 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
106 |
106 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
52 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
224 |
$0.00 |
| D1120 |
Prophylaxis - child |
298 |
298 |
$0.00 |
| D1110 |
Prophylaxis - adult |
230 |
230 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
518 |
518 |
$0.00 |
| D0330 |
Panoramic radiographic image |
325 |
325 |
$0.00 |
| D9110 |
|
15 |
15 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
29 |
$0.00 |