| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
5,390 |
3,896 |
$1.51M |
| D7140 |
Extraction, erupted tooth or exposed root |
13,487 |
2,762 |
$943K |
| D9920 |
|
2,315 |
2,244 |
$701K |
| D9222 |
|
3,766 |
3,671 |
$635K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,085 |
741 |
$316K |
| D8670 |
Periodic orthodontic treatment visit |
919 |
905 |
$276K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,902 |
2,211 |
$236K |
| D1110 |
Prophylaxis - adult |
4,943 |
4,843 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,114 |
5,402 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
6,621 |
6,517 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,674 |
1,101 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,050 |
1,321 |
$103K |
| D1206 |
Topical application of fluoride varnish |
5,267 |
5,204 |
$84K |
| D1120 |
Prophylaxis - child |
2,275 |
2,259 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,486 |
1,465 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,232 |
3,200 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,353 |
1,202 |
$60K |
| D0330 |
Panoramic radiographic image |
1,708 |
1,688 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,210 |
2,180 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
6,565 |
6,453 |
$49K |
| D1351 |
Sealant - per tooth |
1,943 |
360 |
$49K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
41 |
41 |
$42K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
474 |
134 |
$35K |
| D2332 |
|
527 |
342 |
$34K |
| D1330 |
|
3,218 |
3,170 |
$33K |
| D5110 |
|
62 |
60 |
$33K |
| D1310 |
|
3,153 |
3,104 |
$32K |
| D7310 |
|
944 |
314 |
$30K |
| D7240 |
Removal of impacted tooth - completely bony |
136 |
56 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,616 |
1,601 |
$24K |
| D2331 |
|
393 |
264 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
49 |
42 |
$22K |
| D7230 |
|
100 |
57 |
$18K |
| D2330 |
|
346 |
228 |
$17K |
| D8660 |
|
353 |
347 |
$17K |
| D2394 |
|
233 |
188 |
$16K |
| D2335 |
|
192 |
118 |
$13K |
| D3310 |
|
26 |
13 |
$11K |
| D5120 |
|
23 |
21 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$7K |
| D7220 |
|
20 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
865 |
865 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$722.78 |
| D1999 |
|
140 |
122 |
$567.00 |
| D0270 |
|
14 |
14 |
$104.43 |