| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
3,670 |
3,354 |
$2.08M |
| D1999 |
|
2,000 |
1,694 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
776 |
751 |
$48.87 |
| D0220 |
Intraoral - periapical first radiographic image |
583 |
563 |
$28.74 |
| D0120 |
Periodic oral evaluation - established patient |
905 |
881 |
$22.00 |
| D1206 |
Topical application of fluoride varnish |
726 |
702 |
$10.00 |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$0.00 |
| D0330 |
Panoramic radiographic image |
111 |
110 |
$0.00 |
| D1120 |
Prophylaxis - child |
354 |
353 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
117 |
115 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$0.00 |
| D1330 |
|
51 |
51 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
140 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
54 |
$0.00 |
| D0170 |
|
12 |
12 |
$0.00 |