| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
134 |
128 |
$0.00 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
66 |
66 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
29 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
114 |
106 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
114 |
114 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
20 |
$0.00 |