| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
77 |
75 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
119 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
26 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$0.00 |
| D1110 |
Prophylaxis - adult |
32 |
32 |
$0.00 |
| D0330 |
Panoramic radiographic image |
112 |
112 |
$0.00 |