| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,339 |
1,323 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
440 |
430 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,409 |
1,402 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
556 |
551 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
34 |
34 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
92 |
90 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
51 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,289 |
1,281 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
857 |
847 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
135 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
252 |
247 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,433 |
1,417 |
$0.00 |