| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
1,444 |
1,442 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,777 |
2,755 |
$0.00 |
| D0603 |
|
242 |
237 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,478 |
1,474 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,346 |
1,346 |
$0.00 |
| D0602 |
|
324 |
322 |
$0.00 |
| D0601 |
|
449 |
442 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,643 |
2,641 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
351 |
218 |
$0.00 |
| D1351 |
Sealant - per tooth |
126 |
41 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
110 |
110 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$0.00 |
| D1110 |
Prophylaxis - adult |
558 |
556 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
377 |
355 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
2,900 |
2,883 |
$0.00 |
| D0330 |
Panoramic radiographic image |
182 |
182 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
671 |
669 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,352 |
2,350 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
56 |
$0.00 |