| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,988 |
758 |
$368K |
| D7240 |
Removal of impacted tooth - completely bony |
1,336 |
417 |
$306K |
| D0120 |
Periodic oral evaluation - established patient |
2,575 |
2,568 |
$130K |
| D1120 |
Prophylaxis - child |
3,179 |
3,172 |
$116K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,704 |
928 |
$114K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
909 |
478 |
$108K |
| D9222 |
|
744 |
742 |
$90K |
| D9610 |
|
1,916 |
756 |
$60K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,460 |
1,445 |
$58K |
| D1351 |
Sealant - per tooth |
2,238 |
662 |
$57K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
499 |
309 |
$49K |
| D1310 |
|
852 |
851 |
$39K |
| D9993 |
|
573 |
572 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
569 |
342 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
293 |
226 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,089 |
1,089 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,288 |
2,288 |
$22K |
| D7230 |
|
91 |
42 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,088 |
2,432 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
156 |
$11K |
| D0272 |
Bitewings - two radiographic images |
959 |
959 |
$11K |
| D1206 |
Topical application of fluoride varnish |
495 |
494 |
$11K |
| D0603 |
|
736 |
735 |
$11K |
| D0330 |
Panoramic radiographic image |
280 |
280 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
124 |
$8K |
| D0350 |
|
530 |
342 |
$5K |
| D0270 |
|
1,039 |
1,036 |
$5K |
| D9248 |
|
85 |
84 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
198 |
$2K |