| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
1,763 |
1,754 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,919 |
1,910 |
$0.00 |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$0.00 |
| D1354 |
|
3,509 |
950 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
35 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
362 |
360 |
$0.00 |
| D1110 |
Prophylaxis - adult |
42 |
42 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
747 |
747 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,199 |
1,738 |
$0.00 |
| D1351 |
Sealant - per tooth |
2,540 |
811 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,318 |
1,314 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
191 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,820 |
1,811 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,149 |
1,142 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
22 |
$0.00 |