| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,476 |
336 |
$158K |
| D9310 |
|
378 |
370 |
$31K |
| D9222 |
|
268 |
241 |
$17K |
| D9612 |
|
306 |
282 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
37 |
$9K |
| D1206 |
Topical application of fluoride varnish |
475 |
475 |
$9K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
362 |
361 |
$7K |
| D1110 |
Prophylaxis - adult |
122 |
120 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
669 |
592 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
377 |
191 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
79 |
$2K |
| D0330 |
Panoramic radiographic image |
66 |
45 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
51 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
51 |
$1K |
| D0274 |
Bitewings - four radiographic images |
41 |
40 |
$1K |
| D1351 |
Sealant - per tooth |
32 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$523.90 |
| D0210 |
Intraoral - complete series of radiographic images |
21 |
13 |
$453.33 |