| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,468 |
2,025 |
$297K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
60 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
506 |
490 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
978 |
946 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
91 |
68 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
193 |
187 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
51 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
275 |
266 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
359 |
343 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
33 |
$0.00 |
| D1110 |
Prophylaxis - adult |
732 |
709 |
$0.00 |
| D0330 |
Panoramic radiographic image |
322 |
310 |
$0.00 |
| D9110 |
|
71 |
66 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
99 |
$0.00 |