| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,657 |
1,657 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
414 |
414 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
60 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
189 |
189 |
$0.00 |
| D1330 |
|
459 |
459 |
$0.00 |
| D1351 |
Sealant - per tooth |
424 |
108 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
592 |
592 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
575 |
574 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
95 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
247 |
247 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
17 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
798 |
798 |
$0.00 |
| D1120 |
Prophylaxis - child |
810 |
810 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
325 |
275 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,121 |
1,121 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,169 |
1,153 |
$0.00 |
| D0270 |
|
95 |
94 |
$0.00 |