| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,263 |
1,958 |
$28K |
| D1206 |
Topical application of fluoride varnish |
729 |
680 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
101 |
100 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
539 |
460 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
932 |
729 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
250 |
154 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
104 |
50 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
350 |
169 |
$0.00 |
| D1351 |
Sealant - per tooth |
155 |
14 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
384 |
300 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
811 |
688 |
$0.00 |
| D1120 |
Prophylaxis - child |
728 |
554 |
$0.00 |
| D1999 |
|
255 |
228 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
36 |
$0.00 |
| D0270 |
|
62 |
27 |
$0.00 |
| D1110 |
Prophylaxis - adult |
255 |
150 |
$0.00 |
| D1354 |
|
43 |
13 |
$0.00 |