| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,594 |
1,070 |
$299K |
| D7140 |
Extraction, erupted tooth or exposed root |
345 |
144 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
64 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
283 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
136 |
87 |
$0.00 |
| D5899 |
|
71 |
41 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
106 |
90 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$0.00 |
| D1110 |
Prophylaxis - adult |
407 |
317 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
135 |
96 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
325 |
248 |
$0.00 |
| D0330 |
Panoramic radiographic image |
376 |
268 |
$0.00 |
| D9110 |
|
85 |
63 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$0.00 |