| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
48,275 |
46,851 |
$1.51M |
| D1208 |
Topical application of fluoride, excluding varnish |
48,074 |
46,667 |
$864K |
| D0120 |
Periodic oral evaluation - established patient |
29,780 |
29,034 |
$692K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,196 |
5,879 |
$663K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18,166 |
17,529 |
$616K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,363 |
1,942 |
$500K |
| D0272 |
Bitewings - two radiographic images |
22,594 |
21,961 |
$457K |
| D0240 |
|
37,184 |
21,506 |
$451K |
| D0274 |
Bitewings - four radiographic images |
13,492 |
13,034 |
$389K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13,888 |
12,951 |
$362K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,353 |
4,468 |
$351K |
| D0330 |
Panoramic radiographic image |
3,600 |
3,502 |
$185K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,567 |
1,675 |
$168K |
| D0140 |
Limited oral evaluation - problem focused |
5,157 |
4,952 |
$153K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,488 |
277 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
7,365 |
7,266 |
$84K |
| D2934 |
|
620 |
139 |
$79K |
| D1351 |
Sealant - per tooth |
2,347 |
780 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,796 |
5,632 |
$53K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$46K |
| D9420 |
|
450 |
429 |
$32K |
| D8660 |
|
234 |
228 |
$23K |
| D1110 |
Prophylaxis - adult |
306 |
301 |
$15K |
| D2331 |
|
160 |
119 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
141 |
$13K |
| D1206 |
Topical application of fluoride varnish |
785 |
784 |
$10K |
| D1999 |
|
3,459 |
3,046 |
$4K |
| D2330 |
|
49 |
38 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
73 |
$2K |
| D0270 |
|
13 |
13 |
$148.74 |