| Code | Description | Claims | Beneficiaries | Total Paid |
| D1110 |
Prophylaxis - adult |
65,135 |
63,666 |
$2.98M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33,535 |
32,723 |
$1.07M |
| D0120 |
Periodic oral evaluation - established patient |
48,982 |
47,799 |
$991K |
| D9410 |
|
29,370 |
26,836 |
$930K |
| D5110 |
|
572 |
570 |
$465K |
| D5120 |
|
272 |
271 |
$239K |
| D2330 |
|
3,334 |
1,397 |
$218K |
| D1206 |
Topical application of fluoride varnish |
8,888 |
8,492 |
$184K |
| D0140 |
Limited oral evaluation - problem focused |
1,933 |
1,858 |
$68K |
| D4355 |
|
547 |
547 |
$41K |
| D0191 |
|
1,460 |
1,218 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
315 |
114 |
$25K |
| D1354 |
|
621 |
328 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
303 |
203 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
221 |
219 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
541 |
535 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
332 |
317 |
$4K |
| D2331 |
|
38 |
28 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
81 |
$2K |
| D5992 |
|
210 |
188 |
$0.00 |
| D5899 |
|
69 |
52 |
$0.00 |