| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,700 |
4,546 |
$805K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,715 |
3,322 |
$494K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,547 |
4,061 |
$408K |
| D1351 |
Sealant - per tooth |
11,775 |
1,924 |
$358K |
| D1110 |
Prophylaxis - adult |
9,535 |
9,464 |
$357K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,351 |
11,264 |
$336K |
| D0210 |
Intraoral - complete series of radiographic images |
8,263 |
8,157 |
$332K |
| D1120 |
Prophylaxis - child |
7,106 |
7,099 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
10,403 |
10,351 |
$249K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,953 |
7,946 |
$189K |
| D0274 |
Bitewings - four radiographic images |
5,911 |
5,879 |
$171K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,540 |
1,149 |
$159K |
| D0220 |
Intraoral - periapical first radiographic image |
11,316 |
11,141 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
4,394 |
4,310 |
$112K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,008 |
8,269 |
$72K |
| D4341 |
|
457 |
135 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
386 |
291 |
$44K |
| D5213 |
|
53 |
52 |
$40K |
| D5214 |
|
45 |
44 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,297 |
1,295 |
$29K |
| D2331 |
|
343 |
209 |
$24K |
| D2335 |
|
175 |
123 |
$19K |
| D2950 |
|
114 |
84 |
$18K |
| D2332 |
|
195 |
126 |
$17K |
| D2330 |
|
282 |
165 |
$16K |
| D5110 |
|
13 |
13 |
$11K |
| D0270 |
|
237 |
236 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
50 |
$1K |
| D4910 |
|
15 |
15 |
$1K |