| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
792 |
766 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
323 |
299 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
307 |
286 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
607 |
587 |
$0.00 |
| D0603 |
|
79 |
75 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
78 |
$0.00 |
| D0602 |
|
90 |
79 |
$0.00 |
| D0240 |
|
48 |
14 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
452 |
429 |
$0.00 |
| D1120 |
Prophylaxis - child |
741 |
719 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
30 |
25 |
$0.00 |
| D1999 |
|
26 |
25 |
$0.00 |