| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,727 |
3,581 |
$446K |
| D1351 |
Sealant - per tooth |
19,703 |
4,483 |
$365K |
| D1120 |
Prophylaxis - child |
9,255 |
9,018 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
9,124 |
8,911 |
$192K |
| D1110 |
Prophylaxis - adult |
3,942 |
3,823 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,683 |
1,792 |
$146K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,423 |
842 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,472 |
12,153 |
$125K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,412 |
1,351 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,282 |
4,129 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
13,672 |
13,202 |
$103K |
| D0274 |
Bitewings - four radiographic images |
4,978 |
4,821 |
$98K |
| D0272 |
Bitewings - two radiographic images |
6,900 |
6,688 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,098 |
12,151 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,303 |
3,980 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,021 |
685 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,108 |
1,106 |
$67K |
| D0330 |
Panoramic radiographic image |
3,301 |
3,206 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
81 |
27 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
773 |
746 |
$13K |
| D1206 |
Topical application of fluoride varnish |
317 |
314 |
$4K |
| D0270 |
|
250 |
246 |
$936.34 |
| D0603 |
|
12,001 |
11,753 |
$9.06 |
| D0601 |
|
1,948 |
1,855 |
$0.00 |
| D0602 |
|
314 |
311 |
$0.00 |
| D1999 |
|
671 |
607 |
$0.00 |