| Code | Description | Claims | Beneficiaries | Total Paid |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
8,034 |
2,344 |
$1.81M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,072 |
4,731 |
$1.32M |
| D1120 |
Prophylaxis - child |
22,373 |
21,776 |
$951K |
| D0120 |
Periodic oral evaluation - established patient |
27,867 |
27,048 |
$840K |
| D1206 |
Topical application of fluoride varnish |
30,741 |
29,871 |
$777K |
| D1110 |
Prophylaxis - adult |
9,385 |
9,071 |
$601K |
| D1351 |
Sealant - per tooth |
14,854 |
3,973 |
$504K |
| D7240 |
Removal of impacted tooth - completely bony |
1,342 |
375 |
$404K |
| D0272 |
Bitewings - two radiographic images |
15,200 |
14,799 |
$396K |
| D0274 |
Bitewings - four radiographic images |
12,216 |
11,826 |
$395K |
| D0220 |
Intraoral - periapical first radiographic image |
27,365 |
26,408 |
$384K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,783 |
2,270 |
$379K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,899 |
9,025 |
$305K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,841 |
1,086 |
$302K |
| D0230 |
Intraoral - periapical each additional radiographic image |
26,056 |
24,994 |
$284K |
| D0330 |
Panoramic radiographic image |
3,939 |
3,795 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,148 |
3,061 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,467 |
895 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
1,603 |
1,529 |
$70K |
| D0240 |
|
1,779 |
1,569 |
$52K |
| D1330 |
|
9,896 |
9,367 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
146 |
69 |
$21K |
| D9310 |
|
231 |
228 |
$19K |
| D7230 |
|
65 |
29 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
317 |
310 |
$12K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
84 |
50 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0460 |
|
49 |
48 |
$1K |
| D7111 |
|
24 |
13 |
$540.00 |
| D1310 |
|
52 |
32 |
$0.00 |