| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0367 |
|
15 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
463 |
288 |
$0.00 |
| D0330 |
Panoramic radiographic image |
283 |
250 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
395 |
346 |
$0.00 |
| D1110 |
Prophylaxis - adult |
276 |
240 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
368 |
325 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
338 |
105 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
30 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
259 |
228 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
89 |
76 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
13 |
$0.00 |