| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
106 |
92 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
39 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
22 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
15 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
143 |
125 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
316 |
263 |
$0.00 |
| D1110 |
Prophylaxis - adult |
40 |
39 |
$0.00 |
| D1120 |
Prophylaxis - child |
88 |
72 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
32 |
30 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
29 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
15 |
$0.00 |