| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,159 |
672 |
$276K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
734 |
461 |
$61K |
| D9222 |
|
661 |
652 |
$43K |
| D9310 |
|
428 |
426 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
495 |
198 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
245 |
64 |
$32K |
| D1120 |
Prophylaxis - child |
979 |
979 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,462 |
1,461 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,462 |
898 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,327 |
1,326 |
$25K |
| D1110 |
Prophylaxis - adult |
496 |
495 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
262 |
207 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
571 |
556 |
$18K |
| D1351 |
Sealant - per tooth |
541 |
196 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,258 |
1,241 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
662 |
374 |
$12K |
| D7240 |
Removal of impacted tooth - completely bony |
39 |
12 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
69 |
$10K |
| D0274 |
Bitewings - four radiographic images |
308 |
308 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
16 |
$8K |
| D0272 |
Bitewings - two radiographic images |
397 |
397 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
89 |
29 |
$7K |
| D0240 |
|
547 |
317 |
$6K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
174 |
174 |
$5K |
| D9612 |
|
128 |
126 |
$5K |
| D9610 |
|
241 |
239 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
108 |
$3K |