| Code | Description | Claims | Beneficiaries | Total Paid |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
328 |
281 |
$171K |
| D1110 |
Prophylaxis - adult |
2,857 |
2,767 |
$105K |
| D1999 |
|
5,322 |
4,612 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,408 |
5,234 |
$78K |
| D0330 |
Panoramic radiographic image |
1,678 |
1,585 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,659 |
2,466 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,538 |
3,446 |
$67K |
| D1120 |
Prophylaxis - child |
2,070 |
2,009 |
$58K |
| D0274 |
Bitewings - four radiographic images |
3,022 |
2,904 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,645 |
1,563 |
$42K |
| D2160 |
|
482 |
318 |
$36K |
| D3310 |
|
70 |
37 |
$29K |
| D2950 |
|
291 |
185 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,901 |
1,850 |
$25K |
| D2394 |
|
218 |
125 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,271 |
2,150 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
339 |
190 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
179 |
121 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
70 |
$10K |
| D2161 |
|
119 |
67 |
$9K |
| D3320 |
|
14 |
12 |
$7K |
| D2750 |
|
13 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
572 |
321 |
$4K |
| D2335 |
|
38 |
25 |
$4K |
| D2332 |
|
44 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
16 |
$2K |
| D1351 |
Sealant - per tooth |
46 |
12 |
$1K |