| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
295 |
278 |
$0.00 |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
26 |
25 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
102 |
100 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
67 |
65 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
26 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
86 |
74 |
$0.00 |