| Code | Description | Claims | Beneficiaries | Total Paid |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,063 |
1,811 |
$902K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,038 |
1,106 |
$492K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,948 |
1,319 |
$204K |
| D0140 |
Limited oral evaluation - problem focused |
5,811 |
4,987 |
$123K |
| D1120 |
Prophylaxis - child |
4,191 |
3,862 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,289 |
733 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
4,673 |
4,347 |
$67K |
| D3310 |
|
205 |
154 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,111 |
4,716 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
6,204 |
5,170 |
$51K |
| D1999 |
|
2,506 |
2,245 |
$44K |
| D1110 |
Prophylaxis - adult |
1,448 |
1,345 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,837 |
1,509 |
$31K |
| D0330 |
Panoramic radiographic image |
845 |
756 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,249 |
1,118 |
$22K |
| D1354 |
|
1,920 |
435 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,543 |
1,451 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
274 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,467 |
753 |
$10K |
| D0274 |
Bitewings - four radiographic images |
554 |
536 |
$9K |
| D1351 |
Sealant - per tooth |
681 |
201 |
$9K |
| D1206 |
Topical application of fluoride varnish |
426 |
394 |
$9K |
| D3320 |
|
32 |
24 |
$7K |
| D2940 |
|
31 |
28 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
13 |
$1K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$1K |
| D3120 |
|
66 |
38 |
$607.20 |
| D9310 |
|
341 |
321 |
$43.00 |
| D0240 |
|
76 |
65 |
$36.00 |
| D8670 |
Periodic orthodontic treatment visit |
475 |
281 |
$0.00 |
| D0460 |
|
2,657 |
2,289 |
$0.00 |
| D0270 |
|
741 |
640 |
$0.00 |