| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
377 |
276 |
$0.00 |
| D0330 |
Panoramic radiographic image |
29 |
17 |
$0.00 |
| D1110 |
Prophylaxis - adult |
67 |
44 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
184 |
134 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
29 |
20 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
425 |
310 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
125 |
91 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
95 |
63 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
406 |
296 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
20 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
114 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
13 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
23 |
15 |
$0.00 |