| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
970 |
530 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
848 |
450 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
32 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
54 |
26 |
$0.00 |
| D1110 |
Prophylaxis - adult |
532 |
302 |
$0.00 |
| D0330 |
Panoramic radiographic image |
232 |
121 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
48 |
25 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,457 |
801 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
90 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
628 |
341 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
136 |
73 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,500 |
822 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
258 |
149 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,201 |
646 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
42 |
$0.00 |