| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
87 |
84 |
$62K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
122 |
118 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
482 |
261 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
634 |
616 |
$28K |
| D8670 |
Periodic orthodontic treatment visit |
253 |
252 |
$27K |
| D1110 |
Prophylaxis - adult |
343 |
342 |
$12K |
| D9222 |
|
85 |
85 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
130 |
47 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
313 |
313 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
82 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
137 |
135 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
82 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
621 |
$5K |
| D0274 |
Bitewings - four radiographic images |
152 |
152 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
215 |
$4K |
| D3320 |
|
14 |
13 |
$4K |
| D0330 |
Panoramic radiographic image |
158 |
155 |
$4K |
| D1206 |
Topical application of fluoride varnish |
182 |
182 |
$3K |
| D1120 |
Prophylaxis - child |
73 |
73 |
$2K |
| D2331 |
|
19 |
14 |
$1K |
| D2332 |
|
15 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$431.52 |
| D1330 |
|
38 |
38 |
$414.35 |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
49 |
$409.61 |
| D0270 |
|
48 |
48 |
$398.56 |
| D8660 |
|
14 |
14 |
$360.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$300.00 |
| D1310 |
|
25 |
25 |
$255.20 |