| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
70 |
18 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
118 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
459 |
459 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
275 |
$0.00 |
| D1110 |
Prophylaxis - adult |
122 |
122 |
$0.00 |
| D7880 |
|
130 |
130 |
$0.00 |
| D2950 |
|
31 |
27 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
255 |
161 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
183 |
183 |
$0.00 |
| D9994 |
|
640 |
640 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
228 |
148 |
$0.00 |
| D4355 |
|
297 |
297 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
166 |
166 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
682 |
659 |
$0.00 |
| D2331 |
|
14 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
380 |
380 |
$0.00 |
| D2330 |
|
27 |
14 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$0.00 |