| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1999 |
|
159 |
108 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
39 |
$0.00 |
| D1110 |
Prophylaxis - adult |
96 |
69 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
324 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
224 |
147 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
263 |
171 |
$0.00 |
| D4355 |
|
72 |
47 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
137 |
59 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
91 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
60 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
293 |
207 |
$0.00 |