| Code | Description | Claims | Beneficiaries | Total Paid |
| D7140 |
Extraction, erupted tooth or exposed root |
1,405 |
521 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,063 |
518 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,286 |
1,056 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
598 |
339 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
981 |
$24K |
| D1110 |
Prophylaxis - adult |
722 |
671 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
817 |
758 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,108 |
1,023 |
$17K |
| D0274 |
Bitewings - four radiographic images |
637 |
576 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
107 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
464 |
249 |
$11K |
| D2335 |
|
148 |
71 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
981 |
902 |
$8K |
| D0330 |
Panoramic radiographic image |
154 |
138 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
754 |
334 |
$6K |
| D2332 |
|
118 |
69 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
237 |
216 |
$2K |
| D2331 |
|
40 |
26 |
$2K |
| D0270 |
|
44 |
40 |
$605.21 |
| D2394 |
|
15 |
12 |
$417.00 |
| D1120 |
Prophylaxis - child |
60 |
58 |
$172.50 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$81.87 |