| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
20,419 |
10,923 |
$6.40M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
37,029 |
9,259 |
$4.27M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29,206 |
9,771 |
$1.88M |
| D9222 |
|
10,981 |
10,921 |
$1.33M |
| D9420 |
|
14,574 |
14,125 |
$1.29M |
| D9221 |
|
4,962 |
4,484 |
$1.24M |
| D7140 |
Extraction, erupted tooth or exposed root |
18,832 |
7,148 |
$1.04M |
| D3240 |
|
10,201 |
3,687 |
$981K |
| D9220 |
|
4,586 |
4,569 |
$958K |
| D2330 |
|
12,595 |
5,118 |
$939K |
| D9610 |
|
23,955 |
13,518 |
$856K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
8,588 |
2,935 |
$833K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,998 |
12,930 |
$818K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,616 |
4,034 |
$660K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,942 |
4,327 |
$469K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46,569 |
12,806 |
$461K |
| D3230 |
|
4,533 |
1,647 |
$437K |
| D9430 |
|
8,791 |
8,770 |
$278K |
| D1510 |
|
1,737 |
1,279 |
$266K |
| D1120 |
Prophylaxis - child |
7,347 |
7,322 |
$265K |
| D2332 |
|
2,724 |
1,435 |
$221K |
| D0350 |
|
15,793 |
10,638 |
$209K |
| D2331 |
|
2,524 |
1,374 |
$199K |
| D1351 |
Sealant - per tooth |
4,744 |
1,889 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
2,325 |
2,321 |
$116K |
| D1206 |
Topical application of fluoride varnish |
6,947 |
6,927 |
$111K |
| D0272 |
Bitewings - two radiographic images |
7,085 |
7,052 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
964 |
962 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,761 |
2,753 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
481 |
481 |
$25K |
| D2933 |
|
168 |
52 |
$18K |
| D9920 |
|
148 |
148 |
$14K |
| D7960 |
|
27 |
27 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,839 |
1,836 |
$4K |
| D2335 |
|
23 |
13 |
$2K |