| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
175 |
172 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
135 |
132 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
72 |
71 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
142 |
139 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
86 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
15 |
$0.00 |
| D7953 |
|
13 |
12 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
14 |
$0.00 |
| D3120 |
|
18 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
152 |
148 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
192 |
190 |
$0.00 |
| D1110 |
Prophylaxis - adult |
306 |
298 |
$0.00 |
| D2332 |
|
27 |
13 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
39 |
$0.00 |