| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
140 |
138 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
936 |
$0.00 |
| D1120 |
Prophylaxis - child |
272 |
247 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
515 |
473 |
$0.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
47 |
46 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
554 |
524 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
18 |
13 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
553 |
507 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
876 |
704 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
25 |
24 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
47 |
46 |
$0.00 |