| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
6,916 |
3,734 |
$2.93M |
| D9221 |
|
2,184 |
1,326 |
$573K |
| D9222 |
|
3,754 |
3,695 |
$459K |
| D9420 |
|
6,228 |
4,977 |
$456K |
| D9610 |
|
6,603 |
5,050 |
$415K |
| D4341 |
|
5,061 |
1,315 |
$314K |
| D9220 |
|
1,335 |
1,327 |
$288K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
477 |
236 |
$226K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
206 |
172 |
$95K |
| D2952 |
|
666 |
354 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
919 |
911 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
725 |
719 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
503 |
215 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
724 |
720 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
191 |
77 |
$22K |
| D2931 |
|
171 |
118 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
316 |
107 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
101 |
$14K |
| D2140 |
|
196 |
71 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
455 |
443 |
$10K |
| D0274 |
Bitewings - four radiographic images |
393 |
393 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
42 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
216 |
$2K |
| D1110 |
Prophylaxis - adult |
24 |
24 |
$920.00 |