| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0603 |
|
105 |
105 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
81 |
81 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
79 |
79 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
16 |
$0.00 |
| D1120 |
Prophylaxis - child |
105 |
105 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
17 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
27 |
$0.00 |