| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
925 |
900 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,531 |
2,472 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,064 |
2,956 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
578 |
563 |
$0.00 |
| D1354 |
|
807 |
303 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
152 |
143 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
45 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
56 |
54 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
15 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,216 |
2,168 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
948 |
925 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,469 |
2,414 |
$0.00 |
| D9920 |
|
774 |
729 |
$0.00 |
| D0601 |
|
254 |
243 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,671 |
2,546 |
$0.00 |
| D1351 |
Sealant - per tooth |
940 |
285 |
$0.00 |
| D0603 |
|
126 |
121 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
357 |
352 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
212 |
140 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
32 |
30 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
95 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
31 |
$0.00 |
| D1330 |
|
19 |
17 |
$0.00 |