| Code | Description | Claims | Beneficiaries | Total Paid |
| D1120 |
Prophylaxis - child |
10,742 |
10,159 |
$336K |
| D0120 |
Periodic oral evaluation - established patient |
13,040 |
12,340 |
$268K |
| D1351 |
Sealant - per tooth |
10,172 |
1,833 |
$247K |
| D1206 |
Topical application of fluoride varnish |
10,637 |
10,083 |
$217K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,182 |
506 |
$172K |
| D1110 |
Prophylaxis - adult |
3,569 |
3,400 |
$155K |
| D0272 |
Bitewings - two radiographic images |
4,614 |
4,373 |
$100K |
| D0330 |
Panoramic radiographic image |
1,822 |
1,703 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,371 |
3,181 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,601 |
1,435 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,239 |
1,182 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
260 |
163 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
39 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
55 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$1K |
| D0602 |
|
1,494 |
1,441 |
$0.00 |
| D0601 |
|
1,326 |
1,284 |
$0.00 |
| D0603 |
|
3,774 |
3,629 |
$0.00 |