| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
514 |
508 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
705 |
700 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
123 |
123 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
20 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
180 |
177 |
$0.00 |
| D1120 |
Prophylaxis - child |
733 |
727 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
21 |
21 |
$0.00 |