| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
872 |
864 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
760 |
744 |
$0.00 |
| D0330 |
Panoramic radiographic image |
47 |
46 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
173 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
794 |
789 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
371 |
368 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
759 |
697 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
67 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
48 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
84 |
84 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
659 |
654 |
$0.00 |
| D0240 |
|
268 |
91 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
471 |
466 |
$0.00 |
| D1351 |
Sealant - per tooth |
363 |
116 |
$0.00 |