| Code | Description | Claims | Beneficiaries | Total Paid |
| D8670 |
Periodic orthodontic treatment visit |
6,045 |
5,968 |
$293K |
| D0120 |
Periodic oral evaluation - established patient |
18,106 |
18,046 |
$203K |
| D1351 |
Sealant - per tooth |
18,248 |
5,032 |
$173K |
| D1120 |
Prophylaxis - child |
13,909 |
13,859 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,057 |
17,004 |
$101K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,141 |
2,071 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,884 |
2,622 |
$83K |
| D1353 |
|
8,488 |
2,065 |
$68K |
| D1110 |
Prophylaxis - adult |
3,746 |
3,736 |
$54K |
| D0272 |
Bitewings - two radiographic images |
9,383 |
9,361 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,101 |
701 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
780 |
604 |
$26K |
| D7111 |
|
1,293 |
790 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
7,352 |
7,310 |
$23K |
| D2140 |
|
689 |
446 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,815 |
5,713 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
451 |
451 |
$11K |
| D0330 |
Panoramic radiographic image |
653 |
653 |
$9K |
| D9920 |
|
367 |
343 |
$4K |
| D9310 |
|
202 |
200 |
$2K |
| D9110 |
|
65 |
63 |
$387.00 |