| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
81 |
52 |
$392.00 |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
14 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
53 |
30 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
104 |
58 |
$0.00 |
| D1310 |
|
130 |
71 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
140 |
75 |
$0.00 |
| D1330 |
|
132 |
72 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
66 |
$0.00 |
| D0270 |
|
25 |
16 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
25 |
13 |
$0.00 |
| D1999 |
|
81 |
54 |
$0.00 |