| Code | Description | Claims | Beneficiaries | Total Paid |
| D1351 |
Sealant - per tooth |
16,422 |
3,259 |
$317K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,646 |
1,974 |
$250K |
| D1120 |
Prophylaxis - child |
7,912 |
7,843 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
8,821 |
8,742 |
$191K |
| D1110 |
Prophylaxis - adult |
4,198 |
4,170 |
$162K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,715 |
11,620 |
$120K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,093 |
458 |
$115K |
| D0274 |
Bitewings - four radiographic images |
4,767 |
4,734 |
$100K |
| D0220 |
Intraoral - periapical first radiographic image |
12,393 |
12,193 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,423 |
3,398 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,725 |
1,123 |
$88K |
| D0272 |
Bitewings - two radiographic images |
6,250 |
6,190 |
$88K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,153 |
1,101 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,803 |
11,451 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
681 |
681 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,393 |
2,231 |
$41K |
| D7240 |
Removal of impacted tooth - completely bony |
178 |
53 |
$34K |
| D0330 |
Panoramic radiographic image |
2,374 |
2,356 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
186 |
122 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
502 |
486 |
$7K |
| D1206 |
Topical application of fluoride varnish |
348 |
345 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
53 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
44 |
14 |
$3K |
| D0350 |
|
62 |
62 |
$266.51 |
| D0270 |
|
18 |
18 |
$48.51 |
| D0603 |
|
9,788 |
9,475 |
$9.03 |
| D0602 |
|
3,524 |
3,408 |
$0.00 |
| D0601 |
|
476 |
472 |
$0.00 |
| D1999 |
|
182 |
155 |
$0.00 |