| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
35 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
296 |
283 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
291 |
277 |
$0.00 |
| D0240 |
|
24 |
24 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
64 |
63 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
48 |
$0.00 |
| D1351 |
Sealant - per tooth |
151 |
38 |
$0.00 |
| D1120 |
Prophylaxis - child |
246 |
235 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
111 |
$0.00 |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$0.00 |