| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,987 |
5,823 |
$1.20M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,753 |
2,762 |
$629K |
| D1110 |
Prophylaxis - adult |
10,783 |
10,494 |
$485K |
| D0120 |
Periodic oral evaluation - established patient |
19,445 |
18,980 |
$407K |
| D1120 |
Prophylaxis - child |
12,637 |
12,450 |
$378K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,743 |
8,743 |
$259K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,880 |
13,620 |
$207K |
| D0274 |
Bitewings - four radiographic images |
6,825 |
6,634 |
$205K |
| D0330 |
Panoramic radiographic image |
3,896 |
3,852 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,156 |
1,993 |
$185K |
| D1206 |
Topical application of fluoride varnish |
9,617 |
9,390 |
$158K |
| D0220 |
Intraoral - periapical first radiographic image |
9,726 |
9,436 |
$146K |
| D1351 |
Sealant - per tooth |
5,356 |
1,487 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,967 |
3,923 |
$119K |
| D0272 |
Bitewings - two radiographic images |
6,068 |
5,975 |
$109K |
| D0140 |
Limited oral evaluation - problem focused |
3,056 |
3,040 |
$91K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
704 |
395 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,038 |
682 |
$69K |
| D0603 |
|
6,643 |
6,520 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,818 |
5,182 |
$59K |
| D0240 |
|
1,694 |
1,686 |
$57K |
| D0602 |
|
6,221 |
6,091 |
$56K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
115 |
102 |
$48K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
366 |
200 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
329 |
178 |
$30K |
| D2332 |
|
256 |
156 |
$28K |
| D2394 |
|
156 |
101 |
$20K |
| D0145 |
Oral evaluation for a patient under three years of age |
220 |
220 |
$6K |
| D2950 |
|
49 |
42 |
$6K |
| D0601 |
|
282 |
282 |
$2K |
| D3221 |
|
17 |
13 |
$2K |