| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
73 |
73 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
379 |
339 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
20 |
20 |
$0.00 |
| D1110 |
Prophylaxis - adult |
26 |
25 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
63 |
62 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |
| D1330 |
|
46 |
46 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
41 |
$0.00 |
| D1310 |
|
26 |
26 |
$0.00 |
| D0603 |
|
30 |
30 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
51 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$0.00 |