| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
29 |
25 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
26 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
80 |
78 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
27 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
43 |
41 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
90 |
90 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
106 |
104 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
33 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
24 |
$0.00 |