| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
910 |
332 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
635 |
218 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
330 |
87 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
344 |
100 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
319 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
52 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
376 |
133 |
$0.00 |
| D0330 |
Panoramic radiographic image |
208 |
60 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
98 |
26 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,496 |
509 |
$0.00 |