| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
1,364 |
1,245 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
303 |
303 |
$6.89 |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
368 |
$3.33 |
| D1330 |
|
510 |
494 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
92 |
92 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
102 |
102 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
209 |
208 |
$0.00 |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |