| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
29 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
22 |
21 |
$0.00 |
| D0601 |
|
52 |
52 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
97 |
95 |
$0.00 |
| D1351 |
Sealant - per tooth |
129 |
28 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
58 |
58 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
102 |
$0.00 |
| D0602 |
|
62 |
60 |
$0.00 |
| D0603 |
|
32 |
31 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
24 |
23 |
$0.00 |
| D1110 |
Prophylaxis - adult |
35 |
35 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
39 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
62 |
60 |
$0.00 |
| D1120 |
Prophylaxis - child |
68 |
67 |
$0.00 |