| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,540 |
11,481 |
$113K |
| D1110 |
Prophylaxis - adult |
9,561 |
9,513 |
$106K |
| D2330 |
|
2,547 |
969 |
$65K |
| D9410 |
|
3,935 |
3,724 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,496 |
3,489 |
$41K |
| D4341 |
|
783 |
355 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
3,401 |
3,290 |
$20K |
| D9920 |
|
463 |
388 |
$9K |
| D2332 |
|
168 |
102 |
$6K |
| D4342 |
|
147 |
75 |
$4K |
| D2335 |
|
51 |
31 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
115 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
47 |
$2K |
| D4355 |
|
167 |
167 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
109 |
$2K |
| D9910 |
|
291 |
47 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
84 |
$797.06 |
| D5410 |
|
89 |
88 |
$369.01 |
| D2331 |
|
14 |
12 |
$209.00 |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
87 |
$172.50 |
| D9110 |
|
28 |
26 |
$60.00 |