| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
185 |
183 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
79 |
79 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
232 |
229 |
$0.00 |
| D1351 |
Sealant - per tooth |
42 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
41 |
$0.00 |
| D1120 |
Prophylaxis - child |
236 |
233 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
20 |
$0.00 |