| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
15,538 |
15,323 |
$710K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,488 |
2,761 |
$709K |
| D1351 |
Sealant - per tooth |
18,312 |
4,904 |
$648K |
| D0120 |
Periodic oral evaluation - established patient |
18,623 |
18,391 |
$572K |
| D1110 |
Prophylaxis - adult |
5,007 |
4,957 |
$317K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,156 |
1,978 |
$314K |
| D1206 |
Topical application of fluoride varnish |
12,358 |
12,184 |
$312K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,357 |
8,258 |
$193K |
| D0272 |
Bitewings - two radiographic images |
11,810 |
11,633 |
$189K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
911 |
445 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,270 |
725 |
$138K |
| D0274 |
Bitewings - four radiographic images |
5,116 |
5,065 |
$121K |
| D0330 |
Panoramic radiographic image |
2,329 |
2,294 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,871 |
1,832 |
$101K |
| D8670 |
Periodic orthodontic treatment visit |
1,166 |
1,103 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,119 |
3,035 |
$60K |
| D9248 |
|
290 |
287 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,099 |
$52K |
| D3120 |
|
1,397 |
761 |
$48K |
| D1330 |
|
6,394 |
6,340 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
71 |
$15K |
| D8660 |
|
49 |
45 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
264 |
261 |
$3K |
| D7111 |
|
106 |
66 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$612.64 |