| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
439 |
424 |
$0.00 |
| D0180 |
|
194 |
188 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
198 |
$0.00 |
| D4341 |
|
139 |
112 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
366 |
353 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
43 |
$0.00 |
| D0270 |
|
17 |
17 |
$0.00 |
| D1110 |
Prophylaxis - adult |
18 |
18 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
116 |
112 |
$0.00 |
| D1310 |
|
415 |
401 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
186 |
$0.00 |
| D0603 |
|
403 |
390 |
$0.00 |
| D1330 |
|
847 |
769 |
$0.00 |
| D4342 |
|
85 |
68 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
83 |
83 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
25 |
$0.00 |
| D1320 |
|
23 |
18 |
$0.00 |