| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,198 |
2,900 |
$188K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
501 |
394 |
$75K |
| D9222 |
|
2,747 |
2,575 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
3,512 |
3,438 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
5,793 |
5,681 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,394 |
4,136 |
$8K |
| D2950 |
|
150 |
85 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
2,463 |
2,438 |
$4K |
| D1110 |
Prophylaxis - adult |
1,038 |
1,013 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,706 |
1,686 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
318 |
313 |
$2K |
| D1120 |
Prophylaxis - child |
354 |
349 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
474 |
468 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
785 |
776 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
79 |
38 |
$903.30 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
13 |
$444.44 |
| D9612 |
|
92 |
86 |
$296.80 |
| D0272 |
Bitewings - two radiographic images |
96 |
95 |
$245.24 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$183.42 |
| D4355 |
|
49 |
49 |
$52.00 |
| D1206 |
Topical application of fluoride varnish |
40 |
40 |
$19.35 |
| D0270 |
|
12 |
12 |
$18.83 |
| D4910 |
|
27 |
27 |
$0.00 |