| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,872 |
401 |
$156K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,603 |
873 |
$140K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,143 |
376 |
$110K |
| D1120 |
Prophylaxis - child |
3,610 |
3,598 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,424 |
815 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,508 |
4,489 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,632 |
3,620 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,007 |
643 |
$56K |
| D1110 |
Prophylaxis - adult |
819 |
813 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,284 |
1,202 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,821 |
1,814 |
$27K |
| D9222 |
|
411 |
402 |
$22K |
| D1351 |
Sealant - per tooth |
1,085 |
348 |
$18K |
| D9630 |
|
1,111 |
1,085 |
$18K |
| D9612 |
|
400 |
388 |
$13K |
| D0240 |
|
1,113 |
684 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
775 |
769 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
459 |
447 |
$10K |
| D0274 |
Bitewings - four radiographic images |
478 |
475 |
$10K |
| D9248 |
|
115 |
113 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
904 |
876 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
556 |
439 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
300 |
$5K |
| D9310 |
|
61 |
61 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
230 |
230 |
$5K |
| D2330 |
|
100 |
54 |
$2K |
| D0330 |
Panoramic radiographic image |
154 |
153 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
146 |
103 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$550.15 |
| D0270 |
|
14 |
14 |
$203.42 |
| D2331 |
|
16 |
13 |
$0.00 |
| D2332 |
|
23 |
13 |
$0.00 |