| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
31 |
31 |
$0.00 |
| D1999 |
|
90 |
89 |
$0.00 |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
18 |
$0.00 |
| D0330 |
Panoramic radiographic image |
21 |
21 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
31 |
31 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
12 |
$0.00 |