| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
53 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
45 |
45 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
47 |
$0.00 |
| D0330 |
Panoramic radiographic image |
38 |
38 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
20 |
$0.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
45 |
44 |
$0.00 |