| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
711 |
711 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
97 |
95 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
138 |
138 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,108 |
1,108 |
$0.00 |
| D0240 |
|
239 |
137 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
158 |
101 |
$0.00 |
| D9920 |
|
19 |
18 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
400 |
400 |
$0.00 |
| D9630 |
|
141 |
140 |
$0.00 |
| D9992 |
|
35 |
32 |
$0.00 |
| D9310 |
|
19 |
19 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
446 |
446 |
$0.00 |
| D1351 |
Sealant - per tooth |
429 |
129 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
57 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
283 |
281 |
$0.00 |
| D1120 |
Prophylaxis - child |
949 |
949 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
156 |
$0.00 |
| D1110 |
Prophylaxis - adult |
214 |
214 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
126 |
126 |
$0.00 |
| D1354 |
|
177 |
75 |
$0.00 |
| D0330 |
Panoramic radiographic image |
60 |
60 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
109 |
77 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
26 |
$0.00 |