| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
272 |
244 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
136 |
110 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
293 |
291 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
173 |
165 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
32 |
14 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
254 |
252 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
379 |
351 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
745 |
673 |
$0.00 |
| D1110 |
Prophylaxis - adult |
32 |
14 |
$0.00 |