| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,829 |
1,817 |
$0.00 |
| D0330 |
Panoramic radiographic image |
233 |
230 |
$0.00 |
| D1110 |
Prophylaxis - adult |
360 |
360 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
545 |
545 |
$0.00 |
| D1999 |
|
610 |
568 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
370 |
346 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,307 |
1,290 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
57 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
882 |
878 |
$0.00 |
| D1330 |
|
273 |
261 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,041 |
2,030 |
$0.00 |
| D0603 |
|
322 |
319 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,182 |
1,171 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,447 |
921 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
89 |
$0.00 |
| D1351 |
Sealant - per tooth |
313 |
99 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
336 |
171 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,258 |
1,253 |
$0.00 |
| D0240 |
|
129 |
65 |
$0.00 |