| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
79 |
78 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
38 |
33 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
36 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
158 |
154 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
129 |
126 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
61 |
$0.00 |
| D1310 |
|
41 |
27 |
$0.00 |
| D1354 |
|
44 |
15 |
$0.00 |
| D1120 |
Prophylaxis - child |
170 |
162 |
$0.00 |
| D0330 |
Panoramic radiographic image |
15 |
14 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
80 |
75 |
$0.00 |
| D0350 |
|
26 |
17 |
$0.00 |