| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
433 |
418 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
158 |
155 |
$0.00 |
| D1999 |
|
202 |
195 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
143 |
$0.00 |
| D1120 |
Prophylaxis - child |
435 |
425 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
54 |
$0.00 |
| D1110 |
Prophylaxis - adult |
77 |
69 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
549 |
528 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
93 |
91 |
$0.00 |
| D0601 |
|
289 |
284 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
433 |
411 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
197 |
108 |
$0.00 |
| D0603 |
|
150 |
145 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
29 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
92 |
90 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
47 |
$0.00 |
| D0602 |
|
13 |
12 |
$0.00 |