| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
535 |
415 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
3,240 |
3,236 |
$137K |
| D1110 |
Prophylaxis - adult |
1,582 |
1,582 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,848 |
1,848 |
$112K |
| D1120 |
Prophylaxis - child |
2,648 |
2,639 |
$79K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
505 |
177 |
$60K |
| D7230 |
|
309 |
158 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,767 |
2,764 |
$56K |
| D9222 |
|
415 |
415 |
$51K |
| D7240 |
Removal of impacted tooth - completely bony |
215 |
94 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,007 |
1,007 |
$46K |
| D9610 |
|
576 |
429 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,994 |
3,604 |
$35K |
| D1206 |
Topical application of fluoride varnish |
2,888 |
2,885 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
140 |
$16K |
| D0330 |
Panoramic radiographic image |
531 |
531 |
$16K |
| D1351 |
Sealant - per tooth |
693 |
143 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
72 |
$7K |
| D9430 |
|
211 |
207 |
$7K |
| D0272 |
Bitewings - two radiographic images |
198 |
198 |
$2K |
| D0350 |
|
228 |
83 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
99 |
97 |
$1K |