| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
254 |
236 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
704 |
646 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
912 |
888 |
$0.00 |
| D4999 |
|
60 |
42 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
173 |
75 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
171 |
161 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
193 |
141 |
$0.00 |
| D1110 |
Prophylaxis - adult |
1,253 |
1,104 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
106 |
$0.00 |
| D9410 |
|
4,957 |
3,804 |
$0.00 |