| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
95 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
21 |
17 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
171 |
57 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
151 |
115 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
35 |
26 |
$0.00 |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
64 |
$0.00 |
| D1120 |
Prophylaxis - child |
126 |
97 |
$0.00 |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
19 |
$0.00 |