| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
760 |
760 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
225 |
225 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
672 |
672 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$0.00 |
| D1120 |
Prophylaxis - child |
467 |
467 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
138 |
138 |
$0.00 |
| D1110 |
Prophylaxis - adult |
144 |
144 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
164 |
164 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
59 |
57 |
$0.00 |
| D0330 |
Panoramic radiographic image |
67 |
67 |
$0.00 |