| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
387 |
269 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
174 |
139 |
$0.00 |
| D1120 |
Prophylaxis - child |
16 |
14 |
$0.00 |
| D0191 |
|
32 |
32 |
$0.00 |
| D1354 |
|
307 |
46 |
$0.00 |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
28 |
$0.00 |
| D1310 |
|
93 |
87 |
$0.00 |
| D1330 |
|
427 |
326 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
74 |
71 |
$0.00 |
| D0601 |
|
63 |
61 |
$0.00 |
| D0603 |
|
56 |
54 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
55 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
233 |
133 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
49 |
43 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
131 |
77 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
38 |
33 |
$0.00 |