| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,444 |
3,231 |
$550K |
| D1120 |
Prophylaxis - child |
15,404 |
15,216 |
$461K |
| D0120 |
Periodic oral evaluation - established patient |
18,487 |
18,218 |
$387K |
| D1110 |
Prophylaxis - adult |
6,534 |
6,424 |
$295K |
| D0330 |
Panoramic radiographic image |
5,885 |
5,838 |
$285K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,637 |
13,591 |
$203K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,337 |
879 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,723 |
1,659 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,328 |
5,927 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,417 |
1,646 |
$145K |
| D1206 |
Topical application of fluoride varnish |
8,149 |
7,901 |
$140K |
| D0274 |
Bitewings - four radiographic images |
4,290 |
4,217 |
$131K |
| D0272 |
Bitewings - two radiographic images |
7,034 |
6,954 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
3,866 |
3,754 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,605 |
3,556 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
6,405 |
6,207 |
$98K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
658 |
352 |
$83K |
| D0602 |
|
6,190 |
6,082 |
$56K |
| D0603 |
|
5,274 |
5,237 |
$48K |
| D2332 |
|
429 |
256 |
$46K |
| D2331 |
|
499 |
359 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
514 |
326 |
$45K |
| D7240 |
Removal of impacted tooth - completely bony |
100 |
33 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,371 |
1,993 |
$18K |
| D1351 |
Sealant - per tooth |
611 |
202 |
$14K |
| D0145 |
Oral evaluation for a patient under three years of age |
376 |
376 |
$11K |
| D2335 |
|
86 |
67 |
$11K |
| D2140 |
|
125 |
87 |
$7K |
| D9310 |
|
124 |
124 |
$6K |
| D4341 |
|
35 |
12 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
33 |
27 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
25 |
$3K |
| D0240 |
|
70 |
58 |
$2K |
| D2160 |
|
19 |
12 |
$2K |
| D0601 |
|
144 |
144 |
$1K |
| D2330 |
|
19 |
13 |
$1K |
| D3120 |
|
18 |
15 |
$522.90 |
| D1320 |
|
12 |
12 |
$402.48 |