| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
269,531 |
269,529 |
$9.43M |
| D0120 |
Periodic oral evaluation - established patient |
330,638 |
330,634 |
$7.78M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69,445 |
48,472 |
$7.18M |
| D1206 |
Topical application of fluoride varnish |
356,780 |
356,775 |
$5.87M |
| D1110 |
Prophylaxis - adult |
112,972 |
112,969 |
$5.71M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42,812 |
15,792 |
$5.44M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51,624 |
37,067 |
$4.27M |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115,961 |
110,634 |
$3.75M |
| D7140 |
Extraction, erupted tooth or exposed root |
31,702 |
17,599 |
$3.02M |
| D0272 |
Bitewings - two radiographic images |
156,880 |
156,879 |
$2.97M |
| D0330 |
Panoramic radiographic image |
47,669 |
47,666 |
$2.10M |
| D0274 |
Bitewings - four radiographic images |
75,073 |
75,073 |
$2.09M |
| D1351 |
Sealant - per tooth |
69,280 |
21,671 |
$2.07M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
30,559 |
30,557 |
$1.26M |
| D0220 |
Intraoral - periapical first radiographic image |
92,916 |
92,586 |
$1.19M |
| D0230 |
Intraoral - periapical each additional radiographic image |
92,684 |
45,721 |
$965K |
| D0140 |
Limited oral evaluation - problem focused |
19,973 |
19,879 |
$768K |
| D0145 |
Oral evaluation for a patient under three years of age |
14,433 |
14,433 |
$670K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,677 |
3,738 |
$608K |
| D9248 |
|
7,049 |
6,966 |
$458K |
| D9420 |
|
4,177 |
4,176 |
$364K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,457 |
17,457 |
$281K |
| D2330 |
|
675 |
352 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
580 |
310 |
$47K |
| D2932 |
|
152 |
68 |
$23K |
| D7240 |
Removal of impacted tooth - completely bony |
75 |
27 |
$20K |
| D1510 |
|
72 |
48 |
$12K |
| D2390 |
|
79 |
25 |
$12K |
| D0240 |
|
694 |
382 |
$11K |
| D7111 |
|
165 |
120 |
$11K |
| D1354 |
|
734 |
282 |
$10K |
| D2394 |
|
15 |
13 |
$3K |
| D9239 |
|
27 |
27 |
$2K |
| D9243 |
|
26 |
26 |
$2K |
| D2331 |
|
15 |
12 |
$2K |
| D2332 |
|
13 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$701.26 |