| Code | Description | Claims | Beneficiaries | Total Paid |
| T1015 |
Clinic visit/encounter, all-inclusive |
17,692 |
11,181 |
$1.11M |
| D0120 |
Periodic oral evaluation - established patient |
5,394 |
4,232 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,008 |
1,516 |
$46K |
| D0330 |
Panoramic radiographic image |
4,325 |
2,825 |
$43K |
| D1120 |
Prophylaxis - child |
2,107 |
1,964 |
$32K |
| D1351 |
Sealant - per tooth |
3,289 |
686 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
4,772 |
3,073 |
$25K |
| D1110 |
Prophylaxis - adult |
3,420 |
2,234 |
$25K |
| D0274 |
Bitewings - four radiographic images |
4,218 |
2,893 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,722 |
1,479 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,927 |
2,545 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,897 |
4,022 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
9,562 |
6,565 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,423 |
1,655 |
$15K |
| D0272 |
Bitewings - two radiographic images |
956 |
899 |
$6K |
| D1354 |
|
1,181 |
314 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
48 |
26 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
135 |
96 |
$162.00 |
| D0180 |
|
36 |
27 |
$105.40 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
33 |
25 |
$54.00 |
| D0270 |
|
25 |
13 |
$10.00 |
| D0603 |
|
251 |
207 |
$0.00 |
| D2331 |
|
22 |
13 |
$0.00 |
| D9995 |
|
221 |
162 |
$0.00 |
| D0602 |
|
14 |
12 |
$0.00 |
| D1330 |
|
42 |
29 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
41 |
$0.00 |