| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
492 |
485 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
259 |
256 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
274 |
267 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
307 |
163 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
90 |
86 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
28 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
245 |
239 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
318 |
307 |
$0.00 |
| D1110 |
Prophylaxis - adult |
317 |
311 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
39 |
$0.00 |
| D0350 |
|
17 |
13 |
$0.00 |