| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,622 |
3,375 |
$891K |
| D1120 |
Prophylaxis - child |
19,643 |
18,869 |
$711K |
| D0120 |
Periodic oral evaluation - established patient |
17,841 |
17,316 |
$481K |
| D1206 |
Topical application of fluoride varnish |
22,292 |
21,280 |
$466K |
| D1310 |
|
8,857 |
8,217 |
$347K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,072 |
845 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,172 |
2,023 |
$241K |
| D1351 |
Sealant - per tooth |
8,407 |
2,613 |
$238K |
| D0272 |
Bitewings - two radiographic images |
9,079 |
8,705 |
$208K |
| D1330 |
|
8,847 |
8,208 |
$202K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,795 |
4,360 |
$159K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,548 |
844 |
$119K |
| D0425 |
|
2,784 |
2,639 |
$119K |
| D0330 |
Panoramic radiographic image |
1,806 |
1,718 |
$105K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,801 |
2,710 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
3,054 |
2,893 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,320 |
1,247 |
$46K |
| D1354 |
|
1,310 |
578 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
668 |
631 |
$24K |
| D9310 |
|
371 |
344 |
$19K |
| D0603 |
|
1,817 |
1,728 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,585 |
1,332 |
$16K |
| D1110 |
Prophylaxis - adult |
265 |
256 |
$14K |
| D0274 |
Bitewings - four radiographic images |
276 |
273 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
101 |
40 |
$8K |
| D0270 |
|
90 |
88 |
$2K |
| D0350 |
|
1,441 |
1,390 |
$2K |
| D1352 |
|
21 |
12 |
$803.20 |
| D1999 |
|
138 |
133 |
$790.50 |
| D0601 |
|
58 |
57 |
$557.15 |