| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7111 |
|
283 |
174 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
2,254 |
1,977 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
268 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
703 |
702 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
1,264 |
495 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
631 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
3,633 |
3,631 |
$0.00 |
| D2331 |
|
250 |
182 |
$0.00 |
| D5226 |
|
39 |
39 |
$0.00 |
| D2330 |
|
295 |
186 |
$0.00 |
| D1351 |
Sealant - per tooth |
13,079 |
1,563 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
4,462 |
4,460 |
$0.00 |
| D2335 |
|
192 |
134 |
$0.00 |
| D1330 |
|
166 |
166 |
$0.00 |
| D7250 |
|
118 |
66 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
32 |
$0.00 |
| D2722 |
|
75 |
61 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
14 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,326 |
785 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,980 |
1,965 |
$0.00 |
| D2394 |
|
37 |
33 |
$0.00 |
| D0350 |
|
1,342 |
1,337 |
$0.00 |
| D1120 |
Prophylaxis - child |
2,000 |
1,999 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
692 |
644 |
$0.00 |
| D0330 |
Panoramic radiographic image |
1,656 |
1,655 |
$0.00 |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
394 |
385 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,470 |
2,469 |
$0.00 |
| D2332 |
|
106 |
81 |
$0.00 |
| D5225 |
|
14 |
14 |
$0.00 |