| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
539 |
523 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
155 |
152 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
758 |
582 |
$0.00 |
| D0350 |
|
3,016 |
926 |
$0.00 |
| D9993 |
|
14 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
41 |
38 |
$0.00 |
| D9986 |
|
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
444 |
$0.00 |
| D1330 |
|
583 |
508 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
606 |
590 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
550 |
447 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
28 |
$0.00 |
| D1310 |
|
14 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
327 |
311 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
111 |
110 |
$0.00 |
| D1351 |
Sealant - per tooth |
224 |
63 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
249 |
210 |
$0.00 |