| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
69,011 |
13,987 |
$7.58M |
| D9222 |
|
14,493 |
14,208 |
$1.62M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,008 |
223 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
519 |
143 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
447 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
467 |
448 |
$17K |
| D1120 |
Prophylaxis - child |
202 |
202 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
45 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
204 |
203 |
$6K |
| D1351 |
Sealant - per tooth |
39 |
14 |
$2K |