| Code | Description | Claims | Beneficiaries | Total Paid |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,653 |
6,727 |
$1.20M |
| D2740 |
Crown - porcelain/ceramic |
1,410 |
963 |
$857K |
| D1110 |
Prophylaxis - adult |
13,784 |
13,754 |
$567K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,453 |
4,783 |
$551K |
| D1120 |
Prophylaxis - child |
12,846 |
12,836 |
$505K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,853 |
4,189 |
$501K |
| D0120 |
Periodic oral evaluation - established patient |
20,319 |
20,296 |
$497K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,718 |
2,704 |
$439K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
620 |
545 |
$349K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,690 |
14,681 |
$339K |
| D0210 |
Intraoral - complete series of radiographic images |
6,558 |
6,521 |
$315K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,103 |
9,088 |
$313K |
| D0220 |
Intraoral - periapical first radiographic image |
19,886 |
19,618 |
$267K |
| D0274 |
Bitewings - four radiographic images |
8,805 |
8,792 |
$243K |
| D2950 |
|
1,365 |
1,071 |
$213K |
| D0140 |
Limited oral evaluation - problem focused |
6,574 |
6,403 |
$203K |
| D1351 |
Sealant - per tooth |
6,566 |
1,301 |
$183K |
| D3320 |
|
396 |
345 |
$179K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,499 |
1,068 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,481 |
15,054 |
$135K |
| D2331 |
|
1,822 |
1,131 |
$128K |
| D3310 |
|
247 |
171 |
$100K |
| D2332 |
|
819 |
523 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,273 |
3,270 |
$69K |
| D2335 |
|
557 |
397 |
$60K |
| D2330 |
|
1,054 |
642 |
$57K |
| D4341 |
|
197 |
79 |
$27K |
| D2394 |
|
115 |
100 |
$13K |
| D2710 |
|
18 |
15 |
$11K |
| D5110 |
|
26 |
26 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
43 |
$10K |
| D1206 |
Topical application of fluoride varnish |
250 |
250 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
263 |
263 |
$7K |
| D0270 |
|
648 |
644 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
41 |
30 |
$5K |
| D2954 |
|
15 |
13 |
$2K |
| D0350 |
|
13 |
13 |
$0.00 |