| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1330 |
|
16 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
49 |
44 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
104 |
97 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
198 |
147 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
138 |
124 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
30 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
16 |
$0.00 |
| D1120 |
Prophylaxis - child |
102 |
94 |
$0.00 |
| D0330 |
Panoramic radiographic image |
70 |
65 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
155 |
$0.00 |
| D1110 |
Prophylaxis - adult |
41 |
36 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
85 |
78 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$0.00 |