| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,493 |
6,026 |
$1.01M |
| D7140 |
Extraction, erupted tooth or exposed root |
14,195 |
5,698 |
$671K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,629 |
2,624 |
$401K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,328 |
3,452 |
$387K |
| D1120 |
Prophylaxis - child |
9,336 |
9,312 |
$362K |
| D0120 |
Periodic oral evaluation - established patient |
14,660 |
14,636 |
$359K |
| D1110 |
Prophylaxis - adult |
7,771 |
7,756 |
$330K |
| D0210 |
Intraoral - complete series of radiographic images |
6,125 |
6,096 |
$286K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,435 |
8,403 |
$272K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,965 |
9,940 |
$227K |
| D0220 |
Intraoral - periapical first radiographic image |
16,443 |
16,191 |
$202K |
| D0274 |
Bitewings - four radiographic images |
7,263 |
7,244 |
$201K |
| D0140 |
Limited oral evaluation - problem focused |
7,708 |
7,547 |
$201K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,062 |
1,489 |
$169K |
| D5110 |
|
308 |
308 |
$144K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,155 |
10,324 |
$131K |
| D1351 |
Sealant - per tooth |
4,188 |
712 |
$122K |
| D2335 |
|
703 |
499 |
$77K |
| D2332 |
|
887 |
609 |
$76K |
| D2331 |
|
1,167 |
779 |
$73K |
| D2330 |
|
1,149 |
679 |
$60K |
| D5120 |
|
114 |
114 |
$54K |
| D2394 |
|
342 |
242 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,499 |
1,496 |
$32K |
| D4341 |
|
107 |
44 |
$16K |
| D1206 |
Topical application of fluoride varnish |
396 |
396 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
405 |
404 |
$11K |
| D0270 |
|
975 |
965 |
$8K |
| D5214 |
|
14 |
14 |
$8K |
| D5213 |
|
15 |
15 |
$8K |
| D2950 |
|
17 |
15 |
$3K |
| D9310 |
|
50 |
50 |
$1K |