| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
184 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
204 |
204 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
65 |
63 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
137 |
137 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
342 |
341 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
799 |
495 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$0.00 |
| D1110 |
Prophylaxis - adult |
289 |
289 |
$0.00 |
| D0330 |
Panoramic radiographic image |
225 |
225 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
695 |
659 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
404 |
403 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
50 |
36 |
$0.00 |
| D4341 |
|
209 |
92 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
57 |
$0.00 |
| D2950 |
|
37 |
29 |
$0.00 |