| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,817 |
3,488 |
$617K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,383 |
2,539 |
$373K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,437 |
1,626 |
$314K |
| D2740 |
Crown - porcelain/ceramic |
395 |
285 |
$275K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,170 |
2,008 |
$246K |
| D0210 |
Intraoral - complete series of radiographic images |
3,958 |
3,841 |
$199K |
| D1110 |
Prophylaxis - adult |
4,908 |
4,779 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
7,802 |
7,711 |
$185K |
| D1120 |
Prophylaxis - child |
4,638 |
4,621 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,268 |
5,167 |
$174K |
| D0274 |
Bitewings - four radiographic images |
4,998 |
4,936 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,102 |
5,089 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
8,032 |
7,872 |
$106K |
| D5110 |
|
193 |
179 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
2,672 |
2,594 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
887 |
456 |
$73K |
| D2950 |
|
388 |
297 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,436 |
5,681 |
$50K |
| D4341 |
|
225 |
87 |
$28K |
| D0272 |
Bitewings - two radiographic images |
847 |
843 |
$18K |
| D2331 |
|
248 |
175 |
$18K |
| D2394 |
|
104 |
79 |
$16K |
| D2332 |
|
98 |
63 |
$11K |
| D2335 |
|
81 |
63 |
$10K |
| D2330 |
|
174 |
108 |
$9K |
| D5120 |
|
13 |
13 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
95 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
24 |
$2K |