| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,184 |
1,070 |
$124K |
| D1330 |
|
106 |
106 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
152 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
71 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
39 |
39 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
246 |
245 |
$0.00 |
| D1310 |
|
89 |
89 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
379 |
378 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
189 |
189 |
$0.00 |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$0.00 |
| D1120 |
Prophylaxis - child |
65 |
65 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |