| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
246 |
226 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
137 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
272 |
271 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
25 |
$0.00 |
| D9920 |
|
62 |
62 |
$0.00 |
| D9997 |
|
63 |
63 |
$0.00 |
| D1330 |
|
46 |
46 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
220 |
207 |
$0.00 |
| D1110 |
Prophylaxis - adult |
175 |
160 |
$0.00 |
| D0350 |
|
103 |
85 |
$0.00 |
| D1120 |
Prophylaxis - child |
60 |
52 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |