| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,184 |
2,543 |
$421K |
| D1120 |
Prophylaxis - child |
12,079 |
11,916 |
$360K |
| D0120 |
Periodic oral evaluation - established patient |
15,857 |
15,654 |
$331K |
| D1110 |
Prophylaxis - adult |
5,372 |
5,308 |
$241K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,443 |
12,378 |
$184K |
| D0330 |
Panoramic radiographic image |
3,349 |
3,303 |
$161K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
5,568 |
5,035 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,091 |
1,453 |
$123K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,681 |
1,147 |
$109K |
| D0272 |
Bitewings - two radiographic images |
5,164 |
5,118 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,881 |
2,842 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,829 |
4,671 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,913 |
1,902 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,382 |
3,303 |
$51K |
| D1351 |
Sealant - per tooth |
2,030 |
528 |
$48K |
| D0602 |
|
5,390 |
5,335 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
314 |
235 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,578 |
1,545 |
$47K |
| D0603 |
|
2,804 |
2,742 |
$25K |
| D7240 |
Removal of impacted tooth - completely bony |
92 |
30 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,087 |
810 |
$8K |
| D7111 |
|
99 |
74 |
$6K |
| D9310 |
|
97 |
97 |
$5K |
| D0601 |
|
381 |
381 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
15 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
65 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
14 |
$2K |
| D0240 |
|
44 |
44 |
$1K |