| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0601 |
|
57 |
57 |
$0.00 |
| D1330 |
|
336 |
331 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
247 |
243 |
$0.00 |
| D1310 |
|
335 |
330 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
130 |
121 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
376 |
153 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
31 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
419 |
414 |
$0.00 |
| D0602 |
|
290 |
285 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
96 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$0.00 |
| D0603 |
|
119 |
116 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
42 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$0.00 |
| D1351 |
Sealant - per tooth |
50 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
111 |
110 |
$0.00 |
| D1110 |
Prophylaxis - adult |
112 |
109 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
17 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$0.00 |
| D0191 |
|
165 |
163 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
80 |
48 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
247 |
$0.00 |
| D1120 |
Prophylaxis - child |
161 |
160 |
$0.00 |