| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,399 |
473 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,112 |
599 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,027 |
403 |
$69K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
508 |
198 |
$69K |
| D1120 |
Prophylaxis - child |
1,673 |
1,673 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,284 |
2,284 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
621 |
385 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,197 |
2,197 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,849 |
1,392 |
$43K |
| D9310 |
|
481 |
481 |
$40K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
433 |
199 |
$36K |
| D1110 |
Prophylaxis - adult |
724 |
724 |
$34K |
| D1351 |
Sealant - per tooth |
1,042 |
349 |
$34K |
| D9222 |
|
358 |
357 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
671 |
663 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,656 |
1,642 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
77 |
$13K |
| D0272 |
Bitewings - two radiographic images |
572 |
572 |
$11K |
| D0240 |
|
723 |
487 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
240 |
$7K |
| D0274 |
Bitewings - four radiographic images |
227 |
227 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
238 |
237 |
$6K |
| D0330 |
Panoramic radiographic image |
108 |
108 |
$6K |
| D9610 |
|
260 |
259 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
440 |
222 |
$5K |
| D2332 |
|
23 |
12 |
$3K |
| D1510 |
|
15 |
12 |
$2K |