| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
592 |
583 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
313 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
398 |
397 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
349 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
160 |
160 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
246 |
241 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
132 |
110 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$0.00 |