| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0272 |
Bitewings - two radiographic images |
832 |
708 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,397 |
1,259 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,802 |
1,610 |
$0.00 |
| D1330 |
|
61 |
61 |
$0.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
38 |
38 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
32 |
$0.00 |
| D0240 |
|
52 |
17 |
$0.00 |
| D0603 |
|
99 |
98 |
$0.00 |
| D1351 |
Sealant - per tooth |
127 |
28 |
$0.00 |
| D1310 |
|
61 |
61 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
26 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
73 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
455 |
372 |
$0.00 |
| D1120 |
Prophylaxis - child |
1,544 |
1,367 |
$0.00 |
| D1110 |
Prophylaxis - adult |
110 |
110 |
$0.00 |
| T1015 |
Clinic visit/encounter, all-inclusive |
998 |
604 |
$0.00 |
| D0190 |
|
210 |
123 |
$0.00 |
| D0330 |
Panoramic radiographic image |
54 |
39 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
14 |
14 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$0.00 |
| D1354 |
|
52 |
12 |
$0.00 |