| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0602 |
|
977 |
928 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,160 |
3,010 |
$0.00 |
| D0603 |
|
2,036 |
1,926 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
479 |
458 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,109 |
344 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
547 |
534 |
$0.00 |
| D1330 |
|
6,943 |
5,917 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
455 |
426 |
$0.00 |
| D1310 |
|
1,030 |
1,000 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
77 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
272 |
102 |
$0.00 |
| D0601 |
|
59 |
53 |
$0.00 |
| D1351 |
Sealant - per tooth |
76 |
27 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,729 |
1,662 |
$0.00 |
| D0191 |
|
1,703 |
1,655 |
$0.00 |
| D1120 |
Prophylaxis - child |
541 |
527 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,284 |
1,144 |
$0.00 |
| D1354 |
|
2,211 |
585 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
317 |
299 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
119 |
106 |
$0.00 |
| D2140 |
|
127 |
64 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
15 |
$0.00 |