| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
434 |
428 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
303 |
300 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
472 |
466 |
$0.00 |
| D1120 |
Prophylaxis - child |
400 |
396 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
39 |
$0.00 |
| D1354 |
|
56 |
14 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
15 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
52 |
50 |
$0.00 |
| D1110 |
Prophylaxis - adult |
45 |
45 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
16 |
$0.00 |