| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
175 |
174 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
143 |
141 |
$0.00 |
| D0603 |
|
14 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$0.00 |
| D1120 |
Prophylaxis - child |
141 |
140 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
87 |
86 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
19 |
$0.00 |
| D1354 |
|
52 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
17 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
19 |
$0.00 |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$0.00 |