| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,605 |
3,209 |
$445K |
| D0120 |
Periodic oral evaluation - established patient |
756 |
729 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
389 |
366 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
388 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
108 |
108 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
288 |
267 |
$0.00 |
| D0602 |
|
178 |
159 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
482 |
$0.00 |
| D0603 |
|
37 |
37 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
166 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
892 |
876 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,073 |
1,031 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
279 |
224 |
$0.00 |
| D0330 |
Panoramic radiographic image |
751 |
735 |
$0.00 |
| D1999 |
|
815 |
768 |
$0.00 |
| D1110 |
Prophylaxis - adult |
821 |
807 |
$0.00 |
| D1120 |
Prophylaxis - child |
319 |
301 |
$0.00 |
| D9110 |
|
50 |
50 |
$0.00 |