| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
433 |
431 |
$63K |
| D1110 |
Prophylaxis - adult |
189 |
188 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
30 |
30 |
$0.00 |
| D1120 |
Prophylaxis - child |
71 |
71 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
121 |
121 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
61 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$0.00 |