| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
97 |
95 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
52 |
51 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
15 |
$0.00 |
| D1351 |
Sealant - per tooth |
56 |
16 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
60 |
59 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
168 |
165 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
31 |
$0.00 |
| D1999 |
|
120 |
98 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
148 |
145 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$0.00 |