| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
831 |
386 |
$494K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,386 |
2,369 |
$166K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,945 |
826 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
1,765 |
1,754 |
$130K |
| D9430 |
|
3,224 |
3,148 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,697 |
527 |
$101K |
| D9920 |
|
611 |
604 |
$79K |
| D1120 |
Prophylaxis - child |
1,567 |
1,556 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,253 |
510 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,441 |
1,426 |
$71K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
421 |
83 |
$54K |
| D1110 |
Prophylaxis - adult |
551 |
545 |
$49K |
| D9222 |
|
385 |
385 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,516 |
2,486 |
$44K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
405 |
80 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,281 |
2,193 |
$38K |
| D9610 |
|
474 |
374 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,030 |
1,021 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
173 |
92 |
$15K |
| D2330 |
|
178 |
76 |
$14K |
| D0272 |
Bitewings - two radiographic images |
924 |
920 |
$12K |
| D3310 |
|
34 |
12 |
$11K |
| D9410 |
|
338 |
337 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
13 |
$8K |
| D0350 |
|
322 |
94 |
$4K |
| D2335 |
|
26 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
87 |
24 |
$2K |