| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
35 |
34 |
$0.00 |
| D1120 |
Prophylaxis - child |
79 |
78 |
$0.00 |
| D0330 |
Panoramic radiographic image |
20 |
20 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
93 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
60 |
60 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
34 |
$0.00 |
| D0603 |
|
32 |
32 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$0.00 |
| D0602 |
|
19 |
19 |
$0.00 |
| D0601 |
|
22 |
21 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
16 |
$0.00 |