| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
112 |
41 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
38 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
26 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
20 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
34 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
124 |
48 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
126 |
46 |
$0.00 |