| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1330 |
|
1,610 |
1,345 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
336 |
301 |
$0.00 |
| D0603 |
|
952 |
769 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
137 |
131 |
$0.00 |
| D0601 |
|
111 |
93 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
164 |
147 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
142 |
118 |
$0.00 |
| D0602 |
|
107 |
86 |
$0.00 |
| D1320 |
|
57 |
54 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
15 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
54 |
44 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
28 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
167 |
161 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
277 |
254 |
$0.00 |
| D1354 |
|
2,440 |
210 |
$0.00 |
| D1110 |
Prophylaxis - adult |
96 |
96 |
$0.00 |
| D0330 |
Panoramic radiographic image |
104 |
102 |
$0.00 |
| D0191 |
|
155 |
140 |
$0.00 |
| D1120 |
Prophylaxis - child |
117 |
93 |
$0.00 |