| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
339 |
317 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
481 |
478 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,150 |
1,149 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
57 |
57 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
52 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
44 |
44 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
679 |
678 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
381 |
380 |
$0.00 |
| D3120 |
|
66 |
42 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,160 |
1,159 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
508 |
508 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
103 |
$0.00 |
| D0240 |
|
486 |
253 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
510 |
373 |
$0.00 |
| D1351 |
Sealant - per tooth |
43 |
12 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
33 |
$0.00 |