| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,192 |
3,327 |
$667K |
| D8670 |
Periodic orthodontic treatment visit |
5,561 |
5,368 |
$512K |
| D1120 |
Prophylaxis - child |
13,254 |
12,857 |
$363K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,092 |
6,492 |
$321K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,691 |
2,359 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
9,970 |
9,839 |
$266K |
| D1206 |
Topical application of fluoride varnish |
15,657 |
15,203 |
$256K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
288 |
285 |
$244K |
| D1351 |
Sealant - per tooth |
7,299 |
2,051 |
$207K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,821 |
7,251 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,840 |
3,699 |
$167K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
935 |
460 |
$137K |
| D0220 |
Intraoral - periapical first radiographic image |
8,366 |
8,125 |
$128K |
| D0330 |
Panoramic radiographic image |
1,552 |
1,464 |
$88K |
| D1110 |
Prophylaxis - adult |
2,123 |
2,096 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,199 |
775 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,143 |
1,955 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,422 |
3,355 |
$65K |
| D0274 |
Bitewings - four radiographic images |
944 |
935 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
789 |
757 |
$29K |
| D0340 |
|
623 |
555 |
$29K |
| D0470 |
|
624 |
554 |
$23K |
| D2934 |
|
55 |
14 |
$11K |
| D9420 |
|
59 |
58 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
29 |
$5K |
| D7111 |
|
61 |
42 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
18 |
14 |
$2K |
| D0240 |
|
66 |
32 |
$1K |
| D1354 |
|
27 |
12 |
$209.00 |