| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0230 |
Intraoral - periapical each additional radiographic image |
856 |
659 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
85 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
625 |
603 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
668 |
662 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
354 |
346 |
$0.00 |
| D1120 |
Prophylaxis - child |
652 |
646 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
41 |
$0.00 |
| D9430 |
|
13 |
13 |
$0.00 |