| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
88 |
30 |
$0.00 |
| D9248 |
|
28 |
21 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
36 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
279 |
227 |
$0.00 |
| D0240 |
|
27 |
17 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
286 |
236 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
15 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
49 |
41 |
$0.00 |
| D1351 |
Sealant - per tooth |
107 |
23 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
22 |
21 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
20 |
17 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
50 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
146 |
120 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
68 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
110 |
86 |
$0.00 |
| D1120 |
Prophylaxis - child |
222 |
186 |
$0.00 |
| D1110 |
Prophylaxis - adult |
79 |
62 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
38 |
30 |
$0.00 |