| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
561 |
557 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
68 |
68 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
53 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
480 |
476 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
133 |
133 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
370 |
368 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
138 |
137 |
$0.00 |
| D9215 |
|
84 |
84 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
40 |
40 |
$0.00 |
| D0240 |
|
16 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
29 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
16 |
$0.00 |