| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
860 |
849 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,628 |
1,593 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
3,763 |
3,672 |
$0.00 |
| D0330 |
Panoramic radiographic image |
779 |
777 |
$0.00 |
| D1110 |
Prophylaxis - adult |
935 |
926 |
$0.00 |
| D8660 |
|
15 |
15 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
27 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,192 |
3,065 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
2,293 |
2,269 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
360 |
355 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
122 |
107 |
$0.00 |
| D8670 |
Periodic orthodontic treatment visit |
908 |
840 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
569 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
47 |
47 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
141 |
140 |
$0.00 |
| D1351 |
Sealant - per tooth |
77 |
12 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |