| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
2,868 |
2,603 |
$385K |
| D0272 |
Bitewings - two radiographic images |
654 |
653 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,465 |
1,459 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
653 |
652 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
28 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,158 |
1,154 |
$0.00 |
| D1120 |
Prophylaxis - child |
229 |
228 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
25 |
$0.00 |