| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
19 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
101 |
33 |
$0.00 |
| D0330 |
Panoramic radiographic image |
90 |
34 |
$0.00 |
| D1120 |
Prophylaxis - child |
139 |
50 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
42 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
71 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
119 |
44 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
88 |
30 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
67 |
26 |
$0.00 |