| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
16,148 |
5,809 |
$4.08M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17,258 |
4,104 |
$2.01M |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14,517 |
3,543 |
$1.42M |
| D9420 |
|
12,529 |
8,037 |
$969K |
| D7240 |
Removal of impacted tooth - completely bony |
4,148 |
1,545 |
$939K |
| D9222 |
|
5,803 |
5,785 |
$705K |
| D2932 |
|
6,699 |
1,943 |
$692K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,466 |
3,267 |
$618K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,851 |
3,128 |
$605K |
| D9610 |
|
9,486 |
6,585 |
$507K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,980 |
5,936 |
$387K |
| D2335 |
|
2,911 |
1,382 |
$338K |
| D1510 |
|
1,698 |
1,037 |
$320K |
| D9221 |
|
913 |
688 |
$296K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,930 |
1,820 |
$206K |
| D2330 |
|
2,532 |
1,309 |
$193K |
| D9220 |
|
709 |
709 |
$170K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,583 |
4,988 |
$169K |
| D0350 |
|
14,613 |
5,435 |
$169K |
| D7230 |
|
801 |
378 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,929 |
1,027 |
$149K |
| D1351 |
Sealant - per tooth |
2,731 |
1,033 |
$87K |
| D0272 |
Bitewings - two radiographic images |
4,072 |
4,054 |
$47K |
| D1120 |
Prophylaxis - child |
1,357 |
1,348 |
$42K |
| D1310 |
|
1,050 |
1,042 |
$24K |
| D9430 |
|
691 |
610 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,148 |
1,146 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
196 |
196 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
143 |
139 |
$8K |
| D0330 |
Panoramic radiographic image |
279 |
279 |
$8K |
| D0603 |
|
1,046 |
1,038 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
29 |
$7K |
| D9993 |
|
95 |
95 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
470 |
468 |
$5K |
| D0999 |
Unspecified diagnostic procedure, by report |
186 |
165 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
43 |
43 |
$2K |
| D9995 |
|
283 |
240 |
$575.52 |
| D9996 |
|
14 |
14 |
$0.00 |
| D1999 |
|
19 |
19 |
$0.00 |