| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,305 |
6,358 |
$1.09M |
| D7140 |
Extraction, erupted tooth or exposed root |
15,691 |
4,841 |
$801K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,205 |
4,002 |
$687K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,708 |
4,294 |
$574K |
| D1110 |
Prophylaxis - adult |
9,422 |
9,386 |
$372K |
| D5110 |
|
634 |
632 |
$358K |
| D0210 |
Intraoral - complete series of radiographic images |
6,549 |
6,478 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
13,700 |
13,663 |
$307K |
| D2740 |
Crown - porcelain/ceramic |
411 |
213 |
$273K |
| D2394 |
|
1,705 |
1,195 |
$230K |
| D2332 |
|
2,675 |
1,633 |
$228K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,867 |
6,828 |
$216K |
| D5120 |
|
328 |
327 |
$190K |
| D0274 |
Bitewings - four radiographic images |
6,742 |
6,719 |
$177K |
| D2335 |
|
1,457 |
924 |
$160K |
| D1120 |
Prophylaxis - child |
4,130 |
4,119 |
$158K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,477 |
876 |
$145K |
| D0140 |
Limited oral evaluation - problem focused |
5,018 |
4,938 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
9,369 |
9,233 |
$112K |
| D2331 |
|
1,375 |
974 |
$109K |
| D2950 |
|
579 |
336 |
$97K |
| D4341 |
|
635 |
292 |
$92K |
| D1206 |
Topical application of fluoride varnish |
3,763 |
3,753 |
$91K |
| D2330 |
|
1,253 |
811 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,339 |
4,879 |
$49K |
| D7310 |
|
328 |
159 |
$36K |
| D1351 |
Sealant - per tooth |
1,265 |
317 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
907 |
904 |
$21K |
| D0330 |
Panoramic radiographic image |
291 |
290 |
$12K |
| D0272 |
Bitewings - two radiographic images |
566 |
564 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
25 |
$618.00 |