| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,785 |
3,670 |
$651K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,034 |
3,703 |
$633K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,881 |
2,603 |
$285K |
| D1110 |
Prophylaxis - adult |
7,262 |
7,225 |
$282K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,121 |
1,536 |
$232K |
| D1120 |
Prophylaxis - child |
5,137 |
5,123 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,578 |
6,547 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
8,071 |
8,041 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
4,765 |
4,732 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,612 |
4,596 |
$109K |
| D0274 |
Bitewings - four radiographic images |
3,745 |
3,729 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
3,631 |
3,572 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
7,428 |
7,322 |
$96K |
| D2332 |
|
1,139 |
619 |
$86K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
566 |
393 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,199 |
4,768 |
$43K |
| D2330 |
|
721 |
443 |
$43K |
| D4341 |
|
300 |
122 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,640 |
1,634 |
$36K |
| D2335 |
|
166 |
116 |
$23K |
| D1206 |
Topical application of fluoride varnish |
818 |
818 |
$23K |
| D2394 |
|
105 |
81 |
$16K |
| D2750 |
|
17 |
13 |
$10K |
| D2331 |
|
105 |
64 |
$10K |
| D0270 |
|
1,082 |
1,074 |
$9K |
| D1351 |
Sealant - per tooth |
298 |
94 |
$9K |
| D2950 |
|
40 |
27 |
$7K |