| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9630 |
|
303 |
300 |
$0.00 |
| D9995 |
|
1,048 |
828 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
448 |
444 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
127 |
$0.00 |
| D9994 |
|
303 |
300 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
892 |
675 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
31 |
$0.00 |
| D4355 |
|
124 |
124 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
351 |
$0.00 |
| D9920 |
|
924 |
710 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
81 |
80 |
$0.00 |
| D2330 |
|
22 |
12 |
$0.00 |
| D9610 |
|
189 |
172 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
155 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
87 |
$0.00 |
| D7880 |
|
31 |
31 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
371 |
164 |
$0.00 |
| D1354 |
|
608 |
236 |
$0.00 |
| D1110 |
Prophylaxis - adult |
66 |
66 |
$0.00 |
| D0330 |
Panoramic radiographic image |
104 |
104 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
373 |
369 |
$0.00 |
| D4341 |
|
30 |
12 |
$0.00 |