| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,704 |
3,780 |
$668K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,496 |
2,724 |
$333K |
| D1110 |
Prophylaxis - adult |
7,600 |
7,534 |
$291K |
| D1351 |
Sealant - per tooth |
7,352 |
1,758 |
$222K |
| D0120 |
Periodic oral evaluation - established patient |
8,447 |
8,423 |
$205K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,812 |
1,340 |
$202K |
| D1120 |
Prophylaxis - child |
4,894 |
4,888 |
$195K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,358 |
1,795 |
$169K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,596 |
5,541 |
$168K |
| D0210 |
Intraoral - complete series of radiographic images |
3,878 |
3,829 |
$158K |
| D0274 |
Bitewings - four radiographic images |
4,471 |
4,452 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
9,493 |
9,357 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,995 |
4,990 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
2,888 |
2,813 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,632 |
7,309 |
$59K |
| D0272 |
Bitewings - two radiographic images |
1,462 |
1,458 |
$33K |
| D7111 |
|
389 |
228 |
$26K |
| D4341 |
|
170 |
72 |
$24K |
| D1206 |
Topical application of fluoride varnish |
486 |
486 |
$14K |
| D2335 |
|
108 |
79 |
$13K |
| D5225 |
|
14 |
14 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
39 |
$2K |
| D2332 |
|
22 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
39 |
39 |
$1K |
| D2330 |
|
16 |
12 |
$933.84 |