| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1330 |
|
582 |
562 |
$0.00 |
| D0603 |
|
44 |
44 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
332 |
231 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
254 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
286 |
278 |
$0.00 |
| D0602 |
|
132 |
128 |
$0.00 |
| D0601 |
|
133 |
130 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
122 |
89 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
315 |
293 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
397 |
387 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
538 |
202 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
145 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$0.00 |
| D1351 |
Sealant - per tooth |
68 |
18 |
$0.00 |
| D1110 |
Prophylaxis - adult |
286 |
275 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
337 |
$0.00 |
| D4910 |
|
24 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
283 |
277 |
$0.00 |
| D1354 |
|
1,669 |
191 |
$0.00 |
| D1120 |
Prophylaxis - child |
253 |
245 |
$0.00 |
| D0191 |
|
56 |
56 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
50 |
$0.00 |