| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
39 |
39 |
$0.00 |
| D1110 |
Prophylaxis - adult |
18 |
18 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
27 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
14 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
17 |
17 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21 |
19 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$0.00 |