| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
6,720 |
6,614 |
$277K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,519 |
2,512 |
$270K |
| D0120 |
Periodic oral evaluation - established patient |
7,841 |
7,708 |
$219K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,979 |
1,288 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,272 |
5,207 |
$138K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,056 |
846 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,751 |
1,341 |
$82K |
| D1110 |
Prophylaxis - adult |
1,929 |
1,874 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,386 |
2,324 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,734 |
2,671 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,568 |
1,526 |
$47K |
| D1351 |
Sealant - per tooth |
459 |
284 |
$40K |
| D9110 |
|
710 |
687 |
$39K |
| D4341 |
|
198 |
113 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,473 |
1,442 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
3,142 |
3,043 |
$19K |
| D2750 |
|
54 |
36 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,201 |
1,185 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,489 |
1,424 |
$7K |
| D2950 |
|
98 |
80 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
80 |
$6K |
| D2335 |
|
41 |
27 |
$5K |