| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0270 |
|
83 |
79 |
$0.00 |
| D0330 |
Panoramic radiographic image |
199 |
187 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
494 |
448 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
30 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
166 |
103 |
$0.00 |
| D1120 |
Prophylaxis - child |
62 |
55 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
258 |
239 |
$0.00 |
| D9110 |
|
35 |
28 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
919 |
751 |
$0.00 |
| D2332 |
|
28 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,012 |
358 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
95 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
37 |
32 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
201 |
178 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
176 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
62 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
197 |
185 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
179 |
127 |
$0.00 |
| D2330 |
|
42 |
24 |
$0.00 |
| D2331 |
|
19 |
12 |
$0.00 |