| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
1,691 |
1,526 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
5,700 |
5,660 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,049 |
443 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,320 |
1,036 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,195 |
1,186 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
5,207 |
5,152 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
983 |
983 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
209 |
199 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
259 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
38 |
$0.00 |
| D9248 |
|
25 |
25 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
23 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
4,786 |
4,752 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,633 |
1,617 |
$0.00 |
| D1354 |
|
3,712 |
739 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,305 |
2,251 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
890 |
877 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
126 |
126 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
54 |
53 |
$0.00 |