| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,180 |
3,613 |
$1.03M |
| D0603 |
|
211 |
210 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
246 |
139 |
$0.00 |
| D1330 |
|
983 |
971 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
80 |
79 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
789 |
778 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
462 |
462 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
194 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
93 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$0.00 |
| D1351 |
Sealant - per tooth |
54 |
13 |
$0.00 |
| D5899 |
|
14 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
16 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
44 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
143 |
131 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
362 |
$0.00 |
| D1110 |
Prophylaxis - adult |
944 |
932 |
$0.00 |
| D1120 |
Prophylaxis - child |
188 |
188 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
410 |
403 |
$0.00 |
| D9110 |
|
389 |
382 |
$0.00 |
| D2140 |
|
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
41 |
$0.00 |