| Code | Description | Claims | Beneficiaries | Total Paid |
| D1110 |
Prophylaxis - adult |
7,045 |
6,918 |
$331K |
| D0120 |
Periodic oral evaluation - established patient |
12,210 |
11,999 |
$317K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,796 |
1,691 |
$219K |
| D1120 |
Prophylaxis - child |
6,055 |
5,950 |
$212K |
| D0272 |
Bitewings - two radiographic images |
9,433 |
9,311 |
$204K |
| D0210 |
Intraoral - complete series of radiographic images |
2,059 |
1,934 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,846 |
7,735 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,996 |
3,727 |
$101K |
| D1206 |
Topical application of fluoride varnish |
5,022 |
4,911 |
$97K |
| D2160 |
|
759 |
493 |
$68K |
| D0603 |
|
10,996 |
10,754 |
$53K |
| D2140 |
|
731 |
534 |
$47K |
| D1351 |
Sealant - per tooth |
1,635 |
458 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
1,715 |
1,655 |
$26K |
| D0330 |
Panoramic radiographic image |
1,322 |
1,291 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
529 |
515 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
119 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
67 |
36 |
$9K |
| D0274 |
Bitewings - four radiographic images |
555 |
539 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
253 |
$8K |
| D7111 |
|
16 |
13 |
$750.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
24 |
$452.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
27 |
$384.75 |
| D0602 |
|
13 |
13 |
$65.00 |
| D1999 |
|
469 |
428 |
$0.00 |
| D9986 |
|
25 |
21 |
$0.00 |