| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
553 |
548 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
101 |
$0.00 |
| D1110 |
Prophylaxis - adult |
16 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
305 |
302 |
$0.00 |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
30 |
29 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
468 |
464 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
247 |
244 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
585 |
578 |
$0.00 |
| D0603 |
|
271 |
264 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
159 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
459 |
452 |
$0.00 |
| D1351 |
Sealant - per tooth |
36 |
12 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |