| Code | Description | Claims | Beneficiaries | Total Paid |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13,322 |
3,898 |
$1.80M |
| D1206 |
Topical application of fluoride varnish |
54,134 |
53,205 |
$1.45M |
| D1120 |
Prophylaxis - child |
43,683 |
43,558 |
$1.34M |
| D0120 |
Periodic oral evaluation - established patient |
40,810 |
40,702 |
$1.07M |
| D1351 |
Sealant - per tooth |
21,718 |
5,536 |
$651K |
| D0272 |
Bitewings - two radiographic images |
28,795 |
28,708 |
$428K |
| D1999 |
|
35,891 |
34,605 |
$352K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,040 |
2,438 |
$351K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,722 |
8,377 |
$287K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,773 |
1,747 |
$283K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,493 |
4,488 |
$188K |
| D0240 |
|
21,641 |
10,119 |
$167K |
| D0274 |
Bitewings - four radiographic images |
7,478 |
7,449 |
$157K |
| D1110 |
Prophylaxis - adult |
4,144 |
4,132 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,259 |
1,493 |
$148K |
| D0330 |
Panoramic radiographic image |
3,949 |
3,934 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
3,428 |
3,382 |
$85K |
| D9420 |
|
837 |
824 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
10,359 |
10,191 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,957 |
1,951 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,718 |
6,439 |
$43K |
| D1354 |
|
3,043 |
1,231 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
701 |
701 |
$31K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
432 |
278 |
$24K |
| D2140 |
|
295 |
202 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
170 |
80 |
$12K |
| D1510 |
|
20 |
14 |
$3K |
| D2920 |
|
12 |
12 |
$220.00 |
| D1550 |
|
17 |
12 |
$168.00 |