| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
710 |
632 |
$85K |
| D1120 |
Prophylaxis - child |
117 |
106 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
145 |
137 |
$0.00 |
| D0330 |
Panoramic radiographic image |
71 |
70 |
$0.00 |
| D1110 |
Prophylaxis - adult |
195 |
186 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
26 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
188 |
173 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
344 |
324 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
15 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
51 |
50 |
$0.00 |