| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
44,550 |
9,767 |
$2.80M |
| D9222 |
|
11,523 |
9,767 |
$820K |
| D9310 |
|
10,287 |
8,789 |
$533K |
| D9612 |
|
6,017 |
5,946 |
$196K |
| D9630 |
|
5,157 |
5,102 |
$83K |
| D1120 |
Prophylaxis - child |
1,771 |
1,756 |
$57K |
| D1351 |
Sealant - per tooth |
1,642 |
316 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,634 |
1,617 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
938 |
930 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
535 |
$25K |
| D0272 |
Bitewings - two radiographic images |
859 |
846 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
185 |
118 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,695 |
705 |
$18K |
| D0350 |
|
496 |
487 |
$17K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
89 |
26 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
902 |
884 |
$13K |
| D0274 |
Bitewings - four radiographic images |
403 |
399 |
$13K |
| D0330 |
Panoramic radiographic image |
186 |
183 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
90 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
249 |
230 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
17 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
55 |
53 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
75 |
75 |
$1K |
| D9610 |
|
25 |
25 |
$496.75 |
| D1110 |
Prophylaxis - adult |
59 |
54 |
$398.40 |
| D0603 |
|
436 |
434 |
$0.00 |