| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,229 |
1,111 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
74 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
278 |
248 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
241 |
215 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,401 |
1,265 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
260 |
153 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
83 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,099 |
985 |
$0.00 |
| D9420 |
|
16 |
15 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
335 |
300 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
208 |
71 |
$0.00 |
| D1110 |
Prophylaxis - adult |
299 |
271 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,050 |
942 |
$0.00 |
| D0330 |
Panoramic radiographic image |
292 |
262 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
31 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
29 |
$0.00 |