| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1310 |
|
451 |
451 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
940 |
939 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,169 |
1,169 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
158 |
158 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
58 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
358 |
357 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
197 |
134 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
433 |
433 |
$0.00 |
| D1330 |
|
482 |
482 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,286 |
1,286 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
229 |
229 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
259 |
170 |
$0.00 |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$0.00 |