| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,059 |
1,004 |
$0.00 |
| D0270 |
|
25 |
18 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,774 |
1,522 |
$0.00 |
| D4341 |
|
66 |
24 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
310 |
279 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
67 |
$0.00 |
| D1110 |
Prophylaxis - adult |
98 |
83 |
$0.00 |
| D9430 |
|
769 |
633 |
$0.00 |
| D1999 |
|
226 |
185 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
390 |
158 |
$0.00 |
| D9993 |
|
99 |
88 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,614 |
1,227 |
$0.00 |
| D1330 |
|
2,130 |
1,878 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
355 |
332 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,335 |
1,232 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,066 |
932 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
815 |
761 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
56 |
38 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
634 |
540 |
$0.00 |
| D0601 |
|
39 |
38 |
$0.00 |
| D1310 |
|
98 |
88 |
$0.00 |
| D1351 |
Sealant - per tooth |
242 |
71 |
$0.00 |