| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
319 |
301 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
292 |
289 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
214 |
212 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
278 |
276 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
18 |
13 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
51 |
51 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
310 |
303 |
$0.00 |
| D1120 |
Prophylaxis - child |
272 |
269 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
48 |
47 |
$0.00 |