| Code | Description | Claims | Beneficiaries | Total Paid |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,174 |
656 |
$276K |
| D1120 |
Prophylaxis - child |
8,013 |
7,681 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
10,821 |
10,408 |
$230K |
| D1110 |
Prophylaxis - adult |
4,268 |
4,141 |
$195K |
| D1206 |
Topical application of fluoride varnish |
11,184 |
10,718 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,509 |
983 |
$166K |
| D0330 |
Panoramic radiographic image |
2,876 |
2,819 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,993 |
754 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
8,327 |
7,956 |
$128K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
818 |
406 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,145 |
3,099 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,427 |
970 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,673 |
6,173 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,322 |
2,079 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,940 |
1,878 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,086 |
2,947 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,412 |
1,350 |
$43K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
414 |
92 |
$37K |
| D0602 |
|
4,048 |
3,913 |
$37K |
| D0240 |
|
872 |
865 |
$31K |
| D5130 |
|
30 |
30 |
$26K |
| D0603 |
|
1,892 |
1,837 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
963 |
963 |
$15K |
| D4341 |
|
77 |
38 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
49 |
$11K |
| D5226 |
|
13 |
13 |
$9K |
| D2335 |
|
77 |
49 |
$9K |
| D1351 |
Sealant - per tooth |
289 |
71 |
$7K |
| D2332 |
|
41 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
133 |
133 |
$4K |
| D2934 |
|
35 |
13 |
$4K |
| D4342 |
|
43 |
25 |
$4K |
| D7111 |
|
53 |
37 |
$3K |
| D0601 |
|
206 |
206 |
$2K |
| D2331 |
|
18 |
13 |
$2K |
| D2330 |
|
19 |
14 |
$1K |
| D3120 |
|
34 |
15 |
$915.00 |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
23 |
$675.51 |