| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
68 |
68 |
$0.00 |
| D1354 |
|
699 |
120 |
$0.00 |
| D1120 |
Prophylaxis - child |
78 |
78 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
148 |
146 |
$0.00 |
| D1110 |
Prophylaxis - adult |
51 |
51 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
151 |
102 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
103 |
$0.00 |
| D0601 |
|
28 |
28 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
78 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
64 |
62 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
62 |
62 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |