| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
854 |
782 |
$1.32M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,271 |
1,476 |
$697K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
959 |
293 |
$231K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,236 |
619 |
$198K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
694 |
470 |
$188K |
| D1110 |
Prophylaxis - adult |
2,640 |
2,535 |
$184K |
| D0210 |
Intraoral - complete series of radiographic images |
1,828 |
1,730 |
$175K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
928 |
616 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,680 |
2,363 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
1,960 |
1,842 |
$113K |
| D1351 |
Sealant - per tooth |
2,679 |
625 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,302 |
3,146 |
$99K |
| D0160 |
|
730 |
654 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,922 |
1,855 |
$78K |
| D9222 |
|
267 |
251 |
$73K |
| D1120 |
Prophylaxis - child |
1,211 |
1,166 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,826 |
1,403 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,156 |
1,129 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,175 |
2,030 |
$50K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
250 |
120 |
$40K |
| D4355 |
|
197 |
177 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
71 |
55 |
$19K |
| D0330 |
Panoramic radiographic image |
244 |
226 |
$17K |
| D0272 |
Bitewings - two radiographic images |
489 |
442 |
$16K |
| D4341 |
|
60 |
31 |
$15K |
| D2335 |
|
17 |
14 |
$5K |
| D0240 |
|
191 |
91 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
50 |
$4K |
| D9219 |
|
1,714 |
1,400 |
$0.00 |
| D1999 |
|
1,150 |
956 |
$0.00 |
| D0603 |
|
3,743 |
3,175 |
$0.00 |
| D9310 |
|
244 |
235 |
$0.00 |
| D9630 |
|
241 |
235 |
$0.00 |
| D0602 |
|
262 |
251 |
$0.00 |
| D3120 |
|
136 |
67 |
$0.00 |