| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
50 |
18 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
187 |
70 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
66 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
12 |
$0.00 |
| D1999 |
|
195 |
66 |
$0.00 |
| D1120 |
Prophylaxis - child |
185 |
66 |
$0.00 |
| D1110 |
Prophylaxis - adult |
39 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
17 |
$0.00 |