| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$0.00 |
| D1110 |
Prophylaxis - adult |
75 |
75 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
34 |
$0.00 |
| D1120 |
Prophylaxis - child |
30 |
30 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
60 |
60 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
84 |
84 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
19 |
19 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
69 |
68 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$0.00 |