| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
29 |
29 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
121 |
$0.00 |
| D1110 |
Prophylaxis - adult |
93 |
93 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
32 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
120 |
120 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
17 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
13 |
$0.00 |