| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
69 |
57 |
$0.00 |
| D1110 |
Prophylaxis - adult |
251 |
246 |
$0.00 |
| D0350 |
|
193 |
180 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
130 |
128 |
$0.00 |
| D1120 |
Prophylaxis - child |
28 |
28 |
$0.00 |
| D1354 |
|
101 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
215 |
212 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
374 |
369 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
206 |
201 |
$0.00 |
| D9920 |
|
547 |
527 |
$0.00 |
| D9997 |
|
45 |
44 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
338 |
333 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
12 |
$0.00 |