| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
241 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,119 |
1,115 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,758 |
644 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
2,556 |
2,545 |
$0.00 |
| D0603 |
|
2,511 |
2,454 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
25 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,102 |
2,094 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
51 |
48 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
165 |
$0.00 |
| D1351 |
Sealant - per tooth |
770 |
236 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,057 |
1,049 |
$0.00 |
| D1354 |
|
335 |
141 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,968 |
1,961 |
$0.00 |
| D1110 |
Prophylaxis - adult |
614 |
611 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
69 |
67 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
872 |
865 |
$0.00 |
| D0330 |
Panoramic radiographic image |
467 |
464 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
94 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
120 |
119 |
$0.00 |