| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1310 |
|
2,016 |
1,860 |
$0.00 |
| D1330 |
|
3,179 |
2,849 |
$0.00 |
| D0603 |
|
2,142 |
1,859 |
$0.00 |
| D9995 |
|
351 |
345 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
243 |
236 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
937 |
863 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,335 |
1,246 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
599 |
551 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
413 |
207 |
$0.00 |
| D1320 |
|
643 |
603 |
$0.00 |
| D1355 |
|
14,793 |
711 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
87 |
84 |
$0.00 |
| D0601 |
|
75 |
73 |
$0.00 |
| D0602 |
|
161 |
133 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
45 |
27 |
$0.00 |
| D4341 |
|
37 |
14 |
$0.00 |
| D0191 |
|
1,865 |
1,681 |
$0.00 |
| D1354 |
|
20,654 |
997 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
645 |
592 |
$0.00 |
| D1321 |
|
452 |
426 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
397 |
373 |
$0.00 |
| D0330 |
Panoramic radiographic image |
319 |
280 |
$0.00 |
| D1120 |
Prophylaxis - child |
249 |
236 |
$0.00 |
| D1110 |
Prophylaxis - adult |
389 |
363 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
203 |
64 |
$0.00 |
| D9996 |
|
12 |
12 |
$0.00 |