| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
38 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
51 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
47 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
18 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
26 |
$0.00 |
| D0330 |
Panoramic radiographic image |
53 |
46 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
21 |
$0.00 |