| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
67 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
25 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
14 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
74 |
74 |
$0.00 |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
44 |
44 |
$0.00 |