| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
754 |
256 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
895 |
265 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
378 |
97 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
81 |
29 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
28 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
83 |
29 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,425 |
409 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
96 |
34 |
$0.00 |