| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
103 |
103 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
400 |
400 |
$0.00 |
| D1110 |
Prophylaxis - adult |
412 |
412 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
469 |
466 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
105 |
105 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
431 |
431 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
420 |
419 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$0.00 |