| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
90 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
90 |
72 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
23 |
23 |
$0.00 |
| D1351 |
Sealant - per tooth |
61 |
17 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
105 |
85 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
24 |
$0.00 |
| D1110 |
Prophylaxis - adult |
19 |
19 |
$0.00 |