| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
8,318 |
7,874 |
$3.75M |
| D9243 |
|
4,314 |
4,078 |
$1.61M |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15,118 |
4,564 |
$975K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,522 |
1,397 |
$793K |
| D9222 |
|
8,315 |
7,880 |
$761K |
| D2931 |
|
7,478 |
4,325 |
$755K |
| D2140 |
|
7,865 |
2,952 |
$436K |
| D2160 |
|
5,811 |
2,159 |
$423K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,349 |
1,272 |
$301K |
| D9612 |
|
6,276 |
6,027 |
$258K |
| D7240 |
Removal of impacted tooth - completely bony |
1,658 |
512 |
$255K |
| D9239 |
|
4,307 |
4,078 |
$237K |
| D2331 |
|
3,255 |
1,402 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
7,955 |
7,902 |
$204K |
| D4341 |
|
5,952 |
1,537 |
$196K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,881 |
4,835 |
$177K |
| D2332 |
|
1,784 |
822 |
$145K |
| D1206 |
Topical application of fluoride varnish |
8,558 |
8,490 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
5,785 |
5,691 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,133 |
838 |
$117K |
| D0220 |
Intraoral - periapical first radiographic image |
9,901 |
9,721 |
$83K |
| D1110 |
Prophylaxis - adult |
2,266 |
2,261 |
$82K |
| D2330 |
|
1,392 |
742 |
$81K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
608 |
128 |
$77K |
| D9610 |
|
1,759 |
1,639 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,866 |
7,060 |
$69K |
| D0274 |
Bitewings - four radiographic images |
3,800 |
3,779 |
$52K |
| D1120 |
Prophylaxis - child |
2,322 |
2,315 |
$51K |
| D4910 |
|
634 |
621 |
$39K |
| D1999 |
|
2,818 |
2,600 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,708 |
1,583 |
$34K |
| D3310 |
|
89 |
51 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
874 |
868 |
$33K |
| D9995 |
|
967 |
958 |
$13K |
| D9630 |
|
393 |
360 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,284 |
1,274 |
$13K |
| D0330 |
Panoramic radiographic image |
206 |
204 |
$6K |
| D2335 |
|
75 |
55 |
$5K |
| D2950 |
|
104 |
74 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
54 |
$4K |
| D0240 |
|
471 |
250 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
111 |
110 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
28 |
12 |
$2K |
| D0460 |
|
222 |
219 |
$897.25 |
| D7111 |
|
23 |
12 |
$660.10 |
| 81025 |
|
43 |
42 |
$354.48 |
| D9996 |
|
13 |
13 |
$161.00 |
| D9920 |
|
37 |
37 |
$142.41 |
| D0270 |
|
13 |
13 |
$102.96 |