| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,328 |
1,163 |
$1.48M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,617 |
7,137 |
$1.05M |
| D0120 |
Periodic oral evaluation - established patient |
16,805 |
16,784 |
$1.02M |
| D1120 |
Prophylaxis - child |
21,123 |
21,073 |
$846K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,543 |
1,096 |
$527K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,372 |
10,417 |
$447K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,025 |
6,018 |
$380K |
| D0230 |
Intraoral - periapical each additional radiographic image |
93,253 |
25,343 |
$374K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,678 |
2,980 |
$352K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,863 |
3,132 |
$324K |
| D1206 |
Topical application of fluoride varnish |
18,751 |
18,713 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,925 |
2,325 |
$199K |
| D0272 |
Bitewings - two radiographic images |
13,744 |
13,715 |
$159K |
| D1351 |
Sealant - per tooth |
5,752 |
1,768 |
$157K |
| D9222 |
|
1,162 |
1,161 |
$142K |
| D0274 |
Bitewings - four radiographic images |
7,065 |
7,051 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
9,340 |
8,609 |
$108K |
| D0330 |
Panoramic radiographic image |
3,531 |
3,526 |
$102K |
| D9610 |
|
1,906 |
1,158 |
$95K |
| D0350 |
|
10,961 |
5,093 |
$89K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,395 |
1,394 |
$87K |
| D3240 |
|
750 |
453 |
$72K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
736 |
272 |
$70K |
| D2330 |
|
752 |
429 |
$54K |
| D3230 |
|
198 |
70 |
$19K |
| D9430 |
|
605 |
594 |
$19K |
| D2332 |
|
243 |
144 |
$18K |
| D2394 |
|
220 |
168 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
635 |
635 |
$4K |
| D2331 |
|
47 |
34 |
$2K |