| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
66 |
65 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
154 |
147 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13 |
13 |
$0.00 |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
30 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
121 |
$0.00 |
| D9222 |
|
13 |
12 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
80 |
39 |
$0.00 |
| D0350 |
|
44 |
38 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
125 |
$0.00 |