| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
14 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
34 |
$0.00 |
| D0601 |
|
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
37 |
$0.00 |
| D1120 |
Prophylaxis - child |
26 |
26 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$0.00 |