| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
35,865 |
21,721 |
$3.12M |
| D1208 |
Topical application of fluoride, excluding varnish |
2,079 |
1,319 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
3,796 |
2,811 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,477 |
1,943 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,846 |
1,824 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
6,201 |
4,793 |
$0.00 |
| D0603 |
|
3,166 |
2,395 |
$0.00 |
| D0602 |
|
5,806 |
3,979 |
$0.00 |
| D0601 |
|
2,049 |
1,383 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
410 |
338 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,354 |
603 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
139 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
396 |
168 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
152 |
116 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,777 |
2,706 |
$0.00 |
| D1120 |
Prophylaxis - child |
8,389 |
6,126 |
$0.00 |
| D1110 |
Prophylaxis - adult |
800 |
543 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,483 |
1,085 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
702 |
353 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |