| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0603 |
|
78 |
78 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
110 |
110 |
$0.00 |
| D1330 |
|
61 |
61 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
102 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
163 |
163 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
467 |
433 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
45 |
45 |
$0.00 |