| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
155 |
136 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
166 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
780 |
655 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
555 |
337 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
623 |
534 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
336 |
168 |
$0.00 |
| D9920 |
|
140 |
125 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
90 |
77 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
191 |
157 |
$0.00 |
| D4346 |
|
18 |
14 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
619 |
526 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
66 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
448 |
373 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
277 |
225 |
$0.00 |
| D0330 |
Panoramic radiographic image |
210 |
165 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
630 |
156 |
$0.00 |
| D1110 |
Prophylaxis - adult |
130 |
112 |
$0.00 |
| D0270 |
|
62 |
50 |
$0.00 |
| D9110 |
|
20 |
13 |
$0.00 |