| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,616 |
1,585 |
$754K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,836 |
2,051 |
$252K |
| D8670 |
Periodic orthodontic treatment visit |
644 |
642 |
$205K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
422 |
399 |
$202K |
| D9222 |
|
1,481 |
1,476 |
$175K |
| D0140 |
Limited oral evaluation - problem focused |
3,763 |
3,641 |
$168K |
| D1110 |
Prophylaxis - adult |
3,422 |
3,412 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,631 |
697 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,195 |
968 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,267 |
914 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
3,269 |
3,260 |
$64K |
| D1351 |
Sealant - per tooth |
2,234 |
462 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,176 |
1,172 |
$57K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
51 |
51 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,167 |
2,162 |
$45K |
| D0330 |
Panoramic radiographic image |
1,191 |
1,188 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,368 |
1,366 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,145 |
4,087 |
$34K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
276 |
121 |
$32K |
| D2331 |
|
542 |
416 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,429 |
1,427 |
$28K |
| D1120 |
Prophylaxis - child |
866 |
866 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
368 |
329 |
$24K |
| D9920 |
|
154 |
151 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
893 |
868 |
$14K |
| D2332 |
|
218 |
165 |
$14K |
| D2330 |
|
272 |
207 |
$13K |
| D3310 |
|
45 |
33 |
$12K |
| D3320 |
|
31 |
27 |
$11K |
| D0272 |
Bitewings - two radiographic images |
575 |
574 |
$10K |
| D1354 |
|
406 |
238 |
$7K |
| D8660 |
|
244 |
241 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
255 |
244 |
$6K |
| D9248 |
|
30 |
29 |
$6K |
| D2335 |
|
67 |
55 |
$4K |
| D1330 |
|
402 |
400 |
$4K |
| D1310 |
|
396 |
394 |
$4K |
| D0270 |
|
502 |
500 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
35 |
27 |
$3K |
| D2394 |
|
13 |
12 |
$751.50 |
| D4342 |
|
18 |
12 |
$357.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$257.40 |
| D9995 |
|
121 |
118 |
$110.00 |