| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,531 |
1,518 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,493 |
1,468 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
208 |
205 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
348 |
318 |
$0.00 |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
61 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,559 |
1,541 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,382 |
1,366 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
916 |
906 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,430 |
1,361 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
185 |
$0.00 |
| D0603 |
|
270 |
259 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
110 |
52 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
24 |
$0.00 |
| D1351 |
Sealant - per tooth |
43 |
13 |
$0.00 |