| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
626 |
625 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
547 |
546 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
134 |
$0.00 |
| D1351 |
Sealant - per tooth |
37 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
166 |
165 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
242 |
242 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
615 |
609 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
70 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
649 |
646 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
173 |
173 |
$0.00 |
| D1120 |
Prophylaxis - child |
674 |
673 |
$0.00 |
| D1110 |
Prophylaxis - adult |
77 |
77 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
82 |
$0.00 |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
13 |
$0.00 |