| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
68 |
63 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
30 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
16 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
23 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
60 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
42 |
$0.00 |
| D1110 |
Prophylaxis - adult |
52 |
49 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
60 |
56 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
13 |
$0.00 |
| D0330 |
Panoramic radiographic image |
62 |
56 |
$0.00 |