| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
42 |
42 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$0.00 |
| D9630 |
|
55 |
55 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
62 |
33 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
77 |
76 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
28 |
28 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
12 |
$0.00 |