| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
112 |
106 |
$0.00 |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
85 |
85 |
$0.00 |
| D1110 |
Prophylaxis - adult |
39 |
39 |
$0.00 |
| D2950 |
|
34 |
22 |
$0.00 |
| D4341 |
|
37 |
14 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
92 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
88 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$0.00 |