| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
769 |
769 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
368 |
368 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
83 |
83 |
$0.00 |
| D0350 |
|
351 |
346 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$0.00 |
| D1354 |
|
184 |
64 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
29 |
$0.00 |
| D1110 |
Prophylaxis - adult |
221 |
221 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
532 |
532 |
$0.00 |
| D0330 |
Panoramic radiographic image |
52 |
52 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,093 |
1,092 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
475 |
475 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
680 |
680 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
240 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
464 |
463 |
$0.00 |
| D1351 |
Sealant - per tooth |
752 |
213 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
98 |
$0.00 |