| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,524 |
2,125 |
$3.10M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,456 |
2,309 |
$1.02M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,662 |
1,549 |
$476K |
| D1206 |
Topical application of fluoride varnish |
11,655 |
11,239 |
$371K |
| D0120 |
Periodic oral evaluation - established patient |
9,070 |
8,746 |
$369K |
| D1120 |
Prophylaxis - child |
6,638 |
6,411 |
$353K |
| D1110 |
Prophylaxis - adult |
4,575 |
4,453 |
$328K |
| D1351 |
Sealant - per tooth |
6,713 |
1,547 |
$285K |
| D9222 |
|
1,075 |
965 |
$273K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,627 |
4,980 |
$254K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,399 |
702 |
$216K |
| D0274 |
Bitewings - four radiographic images |
3,598 |
3,496 |
$181K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
502 |
345 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
6,199 |
5,858 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,417 |
1,936 |
$118K |
| D0140 |
Limited oral evaluation - problem focused |
1,690 |
1,583 |
$99K |
| D0160 |
|
901 |
775 |
$94K |
| D0240 |
|
2,702 |
1,196 |
$71K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
264 |
94 |
$69K |
| D0330 |
Panoramic radiographic image |
665 |
635 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
361 |
345 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
952 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
402 |
370 |
$29K |
| D9920 |
|
206 |
189 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
107 |
$23K |
| D2140 |
|
65 |
40 |
$7K |
| D2331 |
|
19 |
12 |
$4K |
| D1354 |
|
71 |
27 |
$3K |
| D0350 |
|
50 |
44 |
$2K |
| D3120 |
|
73 |
42 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
12 |
$693.48 |
| D0603 |
|
10,523 |
9,624 |
$0.00 |
| D9310 |
|
716 |
662 |
$0.00 |
| D0602 |
|
4,384 |
4,173 |
$0.00 |
| D9630 |
|
690 |
637 |
$0.00 |
| D9219 |
|
2,691 |
2,503 |
$0.00 |
| D9986 |
|
563 |
548 |
$0.00 |
| D1999 |
|
1,917 |
1,771 |
$0.00 |
| D9987 |
|
14 |
14 |
$0.00 |