| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
379 |
379 |
$0.00 |
| D9994 |
|
477 |
476 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
359 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
195 |
176 |
$0.00 |
| D9920 |
|
420 |
368 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
101 |
101 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
44 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
16 |
16 |
$0.00 |
| D9310 |
|
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
227 |
226 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
114 |
114 |
$0.00 |
| D1120 |
Prophylaxis - child |
225 |
225 |
$0.00 |
| D1110 |
Prophylaxis - adult |
192 |
192 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
21 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
37 |
$0.00 |