| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1321 |
|
31 |
31 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
106 |
$0.00 |
| D1120 |
Prophylaxis - child |
77 |
77 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
37 |
31 |
$0.00 |
| D1310 |
|
22 |
21 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
117 |
113 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
39 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
73 |
73 |
$0.00 |
| D1330 |
|
22 |
22 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$0.00 |
| D1320 |
|
32 |
32 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$0.00 |
| D0603 |
|
21 |
21 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |