| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
102 |
101 |
$70.00 |
| D0220 |
Intraoral - periapical first radiographic image |
105 |
105 |
$26.00 |
| D0210 |
Intraoral - complete series of radiographic images |
54 |
54 |
$0.00 |
| D1310 |
|
17 |
17 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
39 |
39 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
34 |
$0.00 |
| D1330 |
|
96 |
96 |
$0.00 |
| D0603 |
|
14 |
14 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
44 |
43 |
$0.00 |
| D0270 |
|
13 |
13 |
$0.00 |