| Code | Description | Claims | Beneficiaries | Total Paid |
| D1999 |
|
29,480 |
24,489 |
$525K |
| D1120 |
Prophylaxis - child |
20,036 |
18,815 |
$509K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,114 |
2,371 |
$442K |
| D0120 |
Periodic oral evaluation - established patient |
22,415 |
20,910 |
$381K |
| D1206 |
Topical application of fluoride varnish |
19,687 |
18,076 |
$366K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,825 |
2,537 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,147 |
2,704 |
$236K |
| D0330 |
Panoramic radiographic image |
6,196 |
5,776 |
$230K |
| D0272 |
Bitewings - two radiographic images |
12,700 |
11,928 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,556 |
1,978 |
$167K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,982 |
7,727 |
$167K |
| D1110 |
Prophylaxis - adult |
5,054 |
4,607 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,577 |
8,237 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,510 |
5,092 |
$112K |
| D1351 |
Sealant - per tooth |
5,290 |
1,474 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,935 |
4,146 |
$102K |
| D0220 |
Intraoral - periapical first radiographic image |
8,693 |
8,010 |
$85K |
| D0274 |
Bitewings - four radiographic images |
4,458 |
4,019 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,450 |
2,228 |
$59K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
480 |
254 |
$33K |
| D1354 |
|
2,009 |
759 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
813 |
759 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
181 |
159 |
$7K |
| D2335 |
|
69 |
27 |
$6K |
| D2140 |
|
112 |
90 |
$3K |
| D3120 |
|
176 |
110 |
$2K |
| D2330 |
|
26 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
13 |
$1K |
| D1310 |
|
1,284 |
1,197 |
$0.00 |
| D9420 |
|
183 |
152 |
$0.00 |
| D1330 |
|
1,319 |
1,232 |
$0.00 |