| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
62 |
62 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
123 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
262 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
67 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
170 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
40 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
316 |
275 |
$0.00 |
| D1110 |
Prophylaxis - adult |
59 |
57 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
15 |
$0.00 |