| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
38 |
32 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
19 |
18 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
105 |
95 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
17 |
14 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
17 |
15 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
22 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
157 |
125 |
$0.00 |
| D1354 |
|
76 |
25 |
$0.00 |
| D1120 |
Prophylaxis - child |
18 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
17 |
$0.00 |