| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9994 |
|
80 |
79 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
111 |
108 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
77 |
77 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
120 |
115 |
$0.00 |
| D1110 |
Prophylaxis - adult |
29 |
29 |
$0.00 |
| D0330 |
Panoramic radiographic image |
50 |
50 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
64 |
64 |
$0.00 |