| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
689 |
635 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
971 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
852 |
842 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,922 |
1,874 |
$0.00 |
| D1110 |
Prophylaxis - adult |
638 |
629 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
85 |
$0.00 |
| D0350 |
|
60 |
15 |
$0.00 |
| D0330 |
Panoramic radiographic image |
502 |
491 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
82 |
27 |
$0.00 |
| D1999 |
|
96 |
53 |
$0.00 |
| D0240 |
|
292 |
209 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,430 |
2,397 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,574 |
2,546 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,034 |
624 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,149 |
1,132 |
$0.00 |
| D1351 |
Sealant - per tooth |
844 |
241 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
143 |
121 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
741 |
368 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
154 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
13 |
$0.00 |
| D0603 |
|
44 |
27 |
$0.00 |
| D1330 |
|
21 |
20 |
$0.00 |