| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
254 |
250 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
419 |
400 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
242 |
232 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
661 |
639 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
107 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
332 |
322 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
52 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
39 |
$0.00 |