| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
378 |
122 |
$166K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
761 |
175 |
$146K |
| D7140 |
Extraction, erupted tooth or exposed root |
453 |
146 |
$39K |
| D2933 |
|
136 |
43 |
$36K |
| D1120 |
Prophylaxis - child |
602 |
575 |
$29K |
| D9222 |
|
82 |
82 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
734 |
327 |
$18K |
| D1206 |
Topical application of fluoride varnish |
578 |
553 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
396 |
383 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
462 |
435 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
194 |
183 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
58 |
$10K |
| D1351 |
Sealant - per tooth |
241 |
79 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
37 |
$7K |
| D0272 |
Bitewings - two radiographic images |
188 |
178 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
100 |
95 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
129 |
115 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
94 |
86 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
22 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$3K |