| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
4,249 |
3,824 |
$671K |
| D1206 |
Topical application of fluoride varnish |
1,083 |
1,082 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,686 |
1,682 |
$1K |
| D1120 |
Prophylaxis - child |
732 |
731 |
$374.00 |
| D0274 |
Bitewings - four radiographic images |
763 |
761 |
$0.00 |
| D9110 |
|
291 |
285 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
63 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,143 |
1,140 |
$0.00 |
| D0330 |
Panoramic radiographic image |
502 |
500 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
356 |
354 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
303 |
302 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
293 |
293 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
600 |
361 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
114 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| D2331 |
|
16 |
14 |
$0.00 |
| D5899 |
|
67 |
44 |
$0.00 |
| D2330 |
|
24 |
14 |
$0.00 |
| D1351 |
Sealant - per tooth |
72 |
13 |
$0.00 |