| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,071 |
992 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
870 |
862 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
590 |
584 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,700 |
1,668 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,508 |
515 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
977 |
958 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
1,278 |
1,247 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
793 |
234 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,895 |
1,862 |
$0.00 |
| D0170 |
|
182 |
177 |
$0.00 |
| D0603 |
|
579 |
577 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
30 |
$0.00 |
| D9920 |
|
51 |
51 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |
| D5410 |
|
25 |
18 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,831 |
1,690 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,694 |
1,663 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
975 |
955 |
$0.00 |
| D2950 |
|
208 |
146 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
217 |
144 |
$0.00 |
| D1120 |
Prophylaxis - child |
597 |
591 |
$0.00 |
| D4341 |
|
119 |
57 |
$0.00 |
| D2332 |
|
388 |
80 |
$0.00 |
| D0190 |
|
28 |
27 |
$0.00 |