| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
442 |
176 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,413 |
1,413 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,276 |
1,276 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
69 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
81 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
642 |
642 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
133 |
133 |
$0.00 |
| D1351 |
Sealant - per tooth |
638 |
182 |
$0.00 |
| D9420 |
|
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,118 |
1,118 |
$0.00 |
| D1110 |
Prophylaxis - adult |
282 |
282 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
88 |
$0.00 |
| D9219 |
|
16 |
16 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
124 |
124 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$0.00 |