| Code | Description | Claims | Beneficiaries | Total Paid |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,147 |
3,176 |
$741K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,474 |
2,138 |
$435K |
| D1110 |
Prophylaxis - adult |
10,123 |
10,055 |
$407K |
| D2335 |
|
1,089 |
926 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
14,149 |
14,052 |
$312K |
| D2750 |
|
342 |
314 |
$235K |
| D2791 |
|
357 |
334 |
$208K |
| D0274 |
Bitewings - four radiographic images |
8,638 |
8,604 |
$192K |
| D2954 |
|
834 |
779 |
$162K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,878 |
1,425 |
$138K |
| D1120 |
Prophylaxis - child |
3,046 |
3,025 |
$114K |
| D1351 |
Sealant - per tooth |
877 |
867 |
$103K |
| D2394 |
|
730 |
666 |
$97K |
| D3320 |
|
189 |
183 |
$76K |
| D0330 |
Panoramic radiographic image |
4,372 |
4,348 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
2,703 |
2,679 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,659 |
4,633 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
694 |
673 |
$48K |
| D2332 |
|
324 |
296 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,842 |
1,837 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,761 |
1,757 |
$15K |
| D2330 |
|
81 |
74 |
$7K |
| D3310 |
|
12 |
12 |
$6K |
| D2920 |
|
30 |
30 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
50 |
$669.00 |
| D0140 |
Limited oral evaluation - problem focused |
47 |
42 |
$252.36 |