| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1330 |
|
61 |
55 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
23 |
23 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
60 |
54 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
20 |
20 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
56 |
$0.00 |
| D1110 |
Prophylaxis - adult |
14 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
25 |
25 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
59 |
$0.00 |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
15 |
15 |
$0.00 |