| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
66 |
33 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
503 |
496 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
541 |
535 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
114 |
114 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
30 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
22 |
22 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
44 |
44 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
213 |
211 |
$0.00 |
| D1110 |
Prophylaxis - adult |
67 |
66 |
$0.00 |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
471 |
467 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
35 |
$0.00 |