| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
638 |
556 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
334 |
289 |
$0.00 |
| D1310 |
|
247 |
227 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
984 |
900 |
$0.00 |
| D1330 |
|
1,745 |
1,500 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,332 |
2,952 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
355 |
297 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,194 |
1,094 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
177 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
116 |
112 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
614 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
43 |
$0.00 |
| D1351 |
Sealant - per tooth |
181 |
58 |
$0.00 |
| D0603 |
|
57 |
57 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
255 |
204 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,113 |
1,047 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
324 |
224 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
598 |
493 |
$0.00 |
| D9430 |
|
1,934 |
1,643 |
$0.00 |
| D0270 |
|
1,724 |
1,473 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
861 |
799 |
$0.00 |
| D9110 |
|
172 |
131 |
$0.00 |
| D3221 |
|
60 |
48 |
$0.00 |
| D9993 |
|
247 |
227 |
$0.00 |
| D1110 |
Prophylaxis - adult |
154 |
119 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
13 |
$0.00 |