| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
726 |
467 |
$867K |
| D0160 |
|
789 |
593 |
$366K |
| D1110 |
Prophylaxis - adult |
1,379 |
1,210 |
$107K |
| D9222 |
|
533 |
435 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
378 |
331 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
690 |
592 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
266 |
231 |
$33K |
| D9310 |
|
367 |
330 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
449 |
115 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
83 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
25 |
$498.00 |
| D4341 |
|
40 |
12 |
$400.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,418 |
1,246 |
$398.00 |
| D2331 |
|
20 |
12 |
$172.00 |
| D1330 |
|
809 |
691 |
$15.00 |
| D0274 |
Bitewings - four radiographic images |
504 |
449 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
56 |
36 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
34 |
$0.00 |