| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,599 |
1,549 |
$807K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,595 |
1,690 |
$689K |
| D1120 |
Prophylaxis - child |
13,082 |
12,312 |
$399K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,115 |
1,453 |
$306K |
| D1206 |
Topical application of fluoride varnish |
18,074 |
16,994 |
$306K |
| D0120 |
Periodic oral evaluation - established patient |
13,260 |
12,473 |
$297K |
| D1351 |
Sealant - per tooth |
5,041 |
1,531 |
$170K |
| D1110 |
Prophylaxis - adult |
3,480 |
3,252 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,318 |
874 |
$140K |
| D9222 |
|
1,192 |
1,159 |
$119K |
| D0272 |
Bitewings - two radiographic images |
5,548 |
5,224 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,143 |
2,900 |
$101K |
| D9420 |
|
883 |
828 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,101 |
2,857 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,358 |
2,230 |
$90K |
| D8660 |
|
730 |
708 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
5,654 |
5,289 |
$69K |
| D0240 |
|
2,555 |
2,399 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
2,035 |
1,946 |
$68K |
| D0145 |
Oral evaluation for a patient under three years of age |
2,088 |
1,988 |
$65K |
| D0330 |
Panoramic radiographic image |
977 |
913 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
246 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,315 |
1,233 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,032 |
959 |
$16K |
| D2934 |
|
40 |
13 |
$7K |
| D9248 |
|
45 |
42 |
$6K |
| D1353 |
|
166 |
69 |
$6K |
| D1515 |
|
24 |
24 |
$5K |
| D3120 |
|
120 |
79 |
$4K |
| D2941 |
|
69 |
29 |
$3K |
| D0190 |
|
35 |
35 |
$567.27 |
| D0270 |
|
12 |
12 |
$149.28 |