| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,607 |
2,710 |
$1.58M |
| D1110 |
Prophylaxis - adult |
4,177 |
4,160 |
$336K |
| D9222 |
|
2,718 |
2,695 |
$326K |
| D9221 |
|
1,727 |
1,316 |
$324K |
| D9220 |
|
1,360 |
1,353 |
$288K |
| D0120 |
Periodic oral evaluation - established patient |
4,693 |
4,678 |
$275K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,508 |
1,660 |
$249K |
| D9610 |
|
4,677 |
3,962 |
$242K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,697 |
3,682 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
3,743 |
3,731 |
$171K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,274 |
1,210 |
$147K |
| D4910 |
|
1,214 |
1,212 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,682 |
845 |
$86K |
| D9430 |
|
2,688 |
2,673 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,596 |
6,575 |
$85K |
| D1120 |
Prophylaxis - child |
2,281 |
2,273 |
$85K |
| D4341 |
|
1,135 |
297 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,624 |
2,619 |
$54K |
| D2740 |
Crown - porcelain/ceramic |
97 |
53 |
$46K |
| D2931 |
|
388 |
203 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,971 |
2,734 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
292 |
138 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,292 |
2,268 |
$27K |
| D2330 |
|
236 |
121 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
110 |
$12K |
| D0350 |
|
479 |
333 |
$7K |
| D9920 |
|
81 |
81 |
$5K |
| D0272 |
Bitewings - two radiographic images |
390 |
389 |
$5K |
| D4355 |
|
45 |
45 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
44 |
$2K |
| D2140 |
|
25 |
12 |
$1K |
| D2331 |
|
17 |
12 |
$1K |