| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
16 |
16 |
$0.00 |
| D0350 |
|
162 |
154 |
$0.00 |
| D1110 |
Prophylaxis - adult |
37 |
37 |
$0.00 |
| D1120 |
Prophylaxis - child |
105 |
99 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
55 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
43 |
43 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
22 |
22 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
149 |
141 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
144 |
136 |
$0.00 |
| D0603 |
|
200 |
192 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
34 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
64 |
57 |
$0.00 |