| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
61 |
61 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
18 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
69 |
69 |
$0.00 |
| D1110 |
Prophylaxis - adult |
95 |
95 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
13 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
52 |
30 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$0.00 |
| D2140 |
|
21 |
12 |
$0.00 |