| Code | Description | Claims | Beneficiaries | Total Paid |
| D7140 |
Extraction, erupted tooth or exposed root |
3,247 |
1,059 |
$172K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,134 |
610 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
1,591 |
1,333 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,202 |
580 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
669 |
403 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,320 |
1,202 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
864 |
788 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,166 |
1,085 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
266 |
$16K |
| D1110 |
Prophylaxis - adult |
517 |
472 |
$16K |
| D0274 |
Bitewings - four radiographic images |
580 |
536 |
$14K |
| D0330 |
Panoramic radiographic image |
373 |
338 |
$13K |
| D2335 |
|
183 |
91 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
969 |
887 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
694 |
322 |
$5K |
| D2332 |
|
90 |
44 |
$5K |
| D2394 |
|
120 |
86 |
$4K |
| D7250 |
|
65 |
41 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
278 |
254 |
$3K |
| D2330 |
|
21 |
12 |
$79.18 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
16 |
$0.00 |