| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
55 |
37 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
114 |
95 |
$0.00 |
| D0330 |
Panoramic radiographic image |
24 |
17 |
$0.00 |
| D1110 |
Prophylaxis - adult |
20 |
14 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
39 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
34 |
31 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
38 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
20 |
14 |
$0.00 |