| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
43 |
43 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
36 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
120 |
120 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
145 |
145 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
44 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
37 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$0.00 |
| D1110 |
Prophylaxis - adult |
35 |
35 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
63 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
33 |
$0.00 |
| D1120 |
Prophylaxis - child |
128 |
128 |
$0.00 |