| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
485 |
275 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
255 |
$0.00 |
| D9630 |
|
334 |
332 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
414 |
414 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
156 |
$0.00 |
| D9994 |
|
784 |
784 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
349 |
349 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
190 |
190 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
92 |
68 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
80 |
$0.00 |
| D3120 |
|
21 |
17 |
$0.00 |
| D2750 |
|
46 |
32 |
$0.00 |
| D1110 |
Prophylaxis - adult |
661 |
661 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
26 |
$0.00 |
| D0330 |
Panoramic radiographic image |
347 |
347 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
180 |
117 |
$0.00 |
| D3320 |
|
26 |
26 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
284 |
280 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
272 |
272 |
$0.00 |
| D2950 |
|
141 |
110 |
$0.00 |
| D4910 |
|
15 |
15 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |