| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
18,136 |
9,665 |
$4.37M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18,046 |
5,921 |
$2.13M |
| D7240 |
Removal of impacted tooth - completely bony |
8,239 |
3,394 |
$1.88M |
| D0120 |
Periodic oral evaluation - established patient |
27,580 |
27,376 |
$1.75M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,128 |
20,979 |
$1.37M |
| D1120 |
Prophylaxis - child |
27,425 |
27,210 |
$1.23M |
| D7230 |
|
6,453 |
3,394 |
$1.20M |
| D9222 |
|
9,715 |
9,654 |
$1.18M |
| D9610 |
|
20,044 |
9,941 |
$824K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161,165 |
34,301 |
$662K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,016 |
4,881 |
$652K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,476 |
4,816 |
$555K |
| D7140 |
Extraction, erupted tooth or exposed root |
7,478 |
3,373 |
$424K |
| D0330 |
Panoramic radiographic image |
13,595 |
13,497 |
$402K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
5,037 |
2,468 |
$335K |
| D1310 |
|
7,242 |
7,185 |
$330K |
| D1110 |
Prophylaxis - adult |
3,611 |
3,584 |
$311K |
| D2740 |
Crown - porcelain/ceramic |
654 |
510 |
$306K |
| D0210 |
Intraoral - complete series of radiographic images |
6,587 |
6,534 |
$298K |
| D2140 |
|
5,036 |
2,301 |
$272K |
| D1206 |
Topical application of fluoride varnish |
18,623 |
18,502 |
$268K |
| D0274 |
Bitewings - four radiographic images |
12,685 |
12,588 |
$265K |
| D1351 |
Sealant - per tooth |
8,107 |
2,981 |
$251K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,992 |
12,869 |
$247K |
| D7220 |
|
1,689 |
1,001 |
$232K |
| D0350 |
|
19,287 |
9,380 |
$200K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
382 |
297 |
$182K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,509 |
4,236 |
$178K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,385 |
935 |
$162K |
| D9430 |
|
4,212 |
4,067 |
$130K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,281 |
833 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
9,511 |
9,383 |
$109K |
| D4910 |
|
1,419 |
1,413 |
$103K |
| D0272 |
Bitewings - two radiographic images |
7,529 |
7,473 |
$88K |
| D0603 |
|
5,364 |
5,327 |
$79K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,083 |
1,079 |
$75K |
| D2160 |
|
936 |
647 |
$74K |
| D9993 |
|
1,153 |
1,153 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
768 |
532 |
$60K |
| D4341 |
|
748 |
256 |
$48K |
| D2330 |
|
356 |
224 |
$27K |
| D2954 |
|
181 |
149 |
$19K |
| D9999 |
Unspecified adjunctive procedure, by report |
141 |
139 |
$17K |
| D7241 |
|
27 |
16 |
$9K |
| D0602 |
|
524 |
512 |
$8K |
| D2331 |
|
76 |
45 |
$6K |
| D2394 |
|
46 |
13 |
$4K |
| D2335 |
|
52 |
15 |
$3K |
| D1320 |
|
262 |
262 |
$2K |
| D0601 |
|
115 |
115 |
$2K |
| D1330 |
|
15 |
15 |
$0.00 |