| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
18 |
13 |
$0.00 |
| D0330 |
Panoramic radiographic image |
48 |
36 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
35 |
27 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
37 |
$0.00 |
| D1120 |
Prophylaxis - child |
127 |
97 |
$0.00 |
| D1110 |
Prophylaxis - adult |
35 |
27 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
145 |
110 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
138 |
$0.00 |
| D0240 |
|
28 |
14 |
$0.00 |
| D1351 |
Sealant - per tooth |
93 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30 |
23 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
110 |
85 |
$0.00 |