| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
258 |
248 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
344 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
293 |
256 |
$0.00 |
| D1330 |
|
831 |
793 |
$0.00 |
| D0603 |
|
129 |
117 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
49 |
48 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
78 |
$0.00 |
| D0602 |
|
37 |
37 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D0601 |
|
24 |
24 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
433 |
418 |
$0.00 |
| D1120 |
Prophylaxis - child |
262 |
250 |
$0.00 |
| D1110 |
Prophylaxis - adult |
260 |
247 |
$0.00 |
| D0191 |
|
78 |
78 |
$0.00 |
| D1354 |
|
26 |
12 |
$0.00 |