| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
40,859 |
40,343 |
$1.12M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
10,744 |
2,967 |
$1.10M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,365 |
7,382 |
$878K |
| D0120 |
Periodic oral evaluation - established patient |
41,041 |
40,597 |
$784K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,598 |
7,239 |
$594K |
| D1206 |
Topical application of fluoride varnish |
35,515 |
35,092 |
$574K |
| D1351 |
Sealant - per tooth |
23,091 |
7,584 |
$519K |
| D7240 |
Removal of impacted tooth - completely bony |
2,293 |
732 |
$481K |
| D1110 |
Prophylaxis - adult |
12,281 |
12,141 |
$476K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17,090 |
16,461 |
$360K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,500 |
3,548 |
$347K |
| D0210 |
Intraoral - complete series of radiographic images |
6,773 |
6,692 |
$346K |
| D0272 |
Bitewings - two radiographic images |
17,256 |
17,028 |
$267K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,969 |
16,742 |
$264K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,258 |
8,080 |
$212K |
| D0274 |
Bitewings - four radiographic images |
8,561 |
8,470 |
$183K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,494 |
1,231 |
$145K |
| D0330 |
Panoramic radiographic image |
6,219 |
6,141 |
$117K |
| D0145 |
Oral evaluation for a patient under three years of age |
4,335 |
4,283 |
$110K |
| D9310 |
|
3,256 |
3,208 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
960 |
722 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,777 |
2,732 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
7,580 |
7,408 |
$74K |
| D9420 |
|
1,458 |
1,424 |
$59K |
| D7230 |
|
304 |
115 |
$54K |
| D2934 |
|
311 |
110 |
$37K |
| D2140 |
|
262 |
184 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,446 |
1,004 |
$16K |
| D0240 |
|
800 |
751 |
$13K |
| D7111 |
|
161 |
122 |
$7K |
| D7220 |
|
24 |
13 |
$3K |
| D2330 |
|
44 |
25 |
$2K |
| D1999 |
|
5,391 |
5,012 |
$0.00 |