| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
154 |
145 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,051 |
395 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
66 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
256 |
250 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
99 |
$0.00 |
| D1330 |
|
13 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
746 |
656 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
611 |
540 |
$0.00 |
| D1999 |
|
99 |
92 |
$0.00 |
| D1110 |
Prophylaxis - adult |
178 |
173 |
$0.00 |
| D0330 |
Panoramic radiographic image |
76 |
72 |
$0.00 |
| D1120 |
Prophylaxis - child |
57 |
51 |
$0.00 |