| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,205 |
5,438 |
$901K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,406 |
3,124 |
$752K |
| D1120 |
Prophylaxis - child |
20,707 |
20,192 |
$701K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,115 |
11,160 |
$560K |
| D1351 |
Sealant - per tooth |
19,127 |
6,775 |
$539K |
| D0330 |
Panoramic radiographic image |
10,254 |
9,899 |
$514K |
| D0120 |
Periodic oral evaluation - established patient |
16,812 |
16,257 |
$481K |
| D1110 |
Prophylaxis - adult |
9,181 |
8,724 |
$429K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,103 |
4,174 |
$428K |
| D0272 |
Bitewings - two radiographic images |
16,039 |
15,548 |
$305K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,718 |
14,282 |
$281K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,700 |
6,728 |
$260K |
| D1206 |
Topical application of fluoride varnish |
9,478 |
9,292 |
$235K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,873 |
1,774 |
$193K |
| D0220 |
Intraoral - periapical first radiographic image |
11,371 |
10,621 |
$148K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,292 |
910 |
$124K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,351 |
2,299 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
794 |
597 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,464 |
6,579 |
$75K |
| D9920 |
|
1,185 |
951 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
3,139 |
2,936 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
461 |
381 |
$51K |
| D7240 |
Removal of impacted tooth - completely bony |
191 |
82 |
$44K |
| D7111 |
|
469 |
307 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
726 |
628 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,436 |
1,185 |
$22K |
| D2330 |
|
165 |
114 |
$14K |
| D2140 |
|
24 |
14 |
$2K |
| D1999 |
|
796 |
623 |
$2.76 |