| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
63 |
34 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
49 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
114 |
60 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
24 |
12 |
$0.00 |
| D4341 |
|
101 |
39 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
71 |
37 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
418 |
198 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
55 |
$0.00 |
| D0330 |
Panoramic radiographic image |
38 |
19 |
$0.00 |
| D1110 |
Prophylaxis - adult |
30 |
15 |
$0.00 |