| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
15 |
14 |
$0.00 |
| D1120 |
Prophylaxis - child |
21 |
21 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
37 |
$0.00 |
| D1110 |
Prophylaxis - adult |
16 |
15 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
37 |
$0.00 |
| D1351 |
Sealant - per tooth |
71 |
16 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |
| D0603 |
|
93 |
90 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
41 |
40 |
$0.00 |
| D0602 |
|
17 |
17 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
50 |
49 |
$0.00 |