| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
83 |
76 |
$0.00 |
| D0330 |
Panoramic radiographic image |
70 |
64 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
107 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
65 |
59 |
$0.00 |
| D1120 |
Prophylaxis - child |
17 |
15 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
40 |
39 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
95 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
42 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
119 |
110 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
61 |
53 |
$0.00 |