| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
42 |
39 |
$26.18 |
| D0120 |
Periodic oral evaluation - established patient |
774 |
679 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,082 |
1,002 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
245 |
214 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
355 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
695 |
640 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,042 |
946 |
$0.00 |
| D0270 |
|
258 |
235 |
$0.00 |
| D9430 |
|
462 |
395 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
605 |
567 |
$0.00 |
| D1110 |
Prophylaxis - adult |
613 |
556 |
$0.00 |
| D1120 |
Prophylaxis - child |
461 |
440 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$0.00 |