| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
6,331 |
6,211 |
$290K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,490 |
6,343 |
$161K |
| D1110 |
Prophylaxis - adult |
3,147 |
3,056 |
$132K |
| D0272 |
Bitewings - two radiographic images |
7,856 |
7,695 |
$132K |
| D0330 |
Panoramic radiographic image |
3,513 |
3,433 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,598 |
1,001 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,256 |
6,158 |
$92K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
610 |
156 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,000 |
2,930 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,577 |
1,523 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
813 |
544 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,035 |
1,970 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,418 |
2,314 |
$20K |
| D9420 |
|
282 |
269 |
$17K |
| D1351 |
Sealant - per tooth |
769 |
192 |
$14K |
| D0274 |
Bitewings - four radiographic images |
472 |
455 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
228 |
208 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
315 |
313 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
371 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
27 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
30 |
$2K |
| D2330 |
|
24 |
13 |
$1K |
| D1999 |
|
1,627 |
1,531 |
$0.00 |