| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
160 |
148 |
$67.00 |
| D0220 |
Intraoral - periapical first radiographic image |
447 |
408 |
$29.00 |
| D1120 |
Prophylaxis - child |
24 |
12 |
$0.00 |
| D1110 |
Prophylaxis - adult |
64 |
63 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
265 |
261 |
$0.00 |
| D0330 |
Panoramic radiographic image |
46 |
45 |
$0.00 |
| D1354 |
|
1,035 |
220 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
14 |
$0.00 |
| D1310 |
|
188 |
180 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
130 |
96 |
$0.00 |
| D1330 |
|
613 |
593 |
$0.00 |
| D0603 |
|
263 |
248 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
380 |
356 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
352 |
328 |
$0.00 |
| D0601 |
|
51 |
48 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
54 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
36 |
18 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
32 |
16 |
$0.00 |