| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,640 |
4,289 |
$796K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,041 |
3,193 |
$466K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,202 |
2,568 |
$356K |
| D1110 |
Prophylaxis - adult |
7,128 |
7,085 |
$304K |
| D1120 |
Prophylaxis - child |
7,652 |
7,613 |
$268K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,978 |
6,947 |
$250K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,827 |
1,273 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
9,265 |
9,223 |
$214K |
| D0210 |
Intraoral - complete series of radiographic images |
3,794 |
3,775 |
$212K |
| D1351 |
Sealant - per tooth |
6,894 |
1,254 |
$197K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,827 |
7,791 |
$164K |
| D0274 |
Bitewings - four radiographic images |
4,560 |
4,544 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
9,258 |
9,136 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
2,625 |
2,579 |
$86K |
| D4341 |
|
405 |
160 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,571 |
7,005 |
$58K |
| D2331 |
|
383 |
224 |
$31K |
| D2710 |
|
50 |
43 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,400 |
1,391 |
$28K |
| D2335 |
|
187 |
141 |
$27K |
| D2330 |
|
380 |
238 |
$25K |
| D2394 |
|
122 |
98 |
$21K |
| D2950 |
|
123 |
101 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
32 |
29 |
$18K |
| D2332 |
|
163 |
109 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
106 |
86 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
119 |
91 |
$13K |
| D1206 |
Topical application of fluoride varnish |
549 |
547 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
388 |
386 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30 |
26 |
$5K |
| D0270 |
|
25 |
25 |
$261.60 |