| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
28 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
92 |
54 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
81 |
52 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
27 |
14 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
30 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
150 |
89 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
517 |
279 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
74 |
48 |
$0.00 |
| D0330 |
Panoramic radiographic image |
44 |
30 |
$0.00 |
| D1120 |
Prophylaxis - child |
92 |
54 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
15 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
27 |
$0.00 |