| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15,772 |
10,132 |
$1.61M |
| D1110 |
Prophylaxis - adult |
29,062 |
29,062 |
$1.47M |
| D1120 |
Prophylaxis - child |
33,872 |
33,872 |
$1.19M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,671 |
8,202 |
$1.11M |
| D0120 |
Periodic oral evaluation - established patient |
39,780 |
39,780 |
$935K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,881 |
21,881 |
$900K |
| D0274 |
Bitewings - four radiographic images |
26,849 |
26,849 |
$742K |
| D1351 |
Sealant - per tooth |
23,080 |
7,516 |
$698K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,363 |
1,163 |
$569K |
| D0330 |
Panoramic radiographic image |
15,563 |
15,563 |
$555K |
| D1206 |
Topical application of fluoride varnish |
31,353 |
31,353 |
$521K |
| D1208 |
Topical application of fluoride, excluding varnish |
28,198 |
28,198 |
$464K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,475 |
2,737 |
$450K |
| D0272 |
Bitewings - two radiographic images |
23,382 |
23,382 |
$446K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,555 |
2,811 |
$436K |
| D7240 |
Removal of impacted tooth - completely bony |
1,553 |
470 |
$432K |
| D0220 |
Intraoral - periapical first radiographic image |
32,811 |
32,507 |
$426K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12,017 |
11,044 |
$394K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,274 |
24,576 |
$272K |
| D0140 |
Limited oral evaluation - problem focused |
6,230 |
6,203 |
$232K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,233 |
778 |
$173K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
276 |
259 |
$157K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,036 |
3,036 |
$143K |
| D9222 |
|
990 |
990 |
$102K |
| D7111 |
|
1,337 |
924 |
$89K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
690 |
535 |
$64K |
| D2950 |
|
399 |
312 |
$55K |
| D2331 |
|
482 |
318 |
$41K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
13 |
13 |
$31K |
| D2330 |
|
430 |
263 |
$29K |
| D2934 |
|
80 |
26 |
$10K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
100 |
57 |
$8K |
| D7230 |
|
25 |
12 |
$6K |
| D2332 |
|
58 |
38 |
$6K |
| D9310 |
|
54 |
54 |
$3K |
| D2931 |
|
42 |
40 |
$3K |
| D0270 |
|
17 |
17 |
$207.74 |