| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 41899 |
Unlisted procedure, dentoalveolar structures |
9,573 |
9,444 |
$7.20M |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
14,507 |
9,051 |
$2.23M |
| D9220 |
|
5,290 |
5,244 |
$1.09M |
| D9222 |
|
9,127 |
8,862 |
$1.06M |
| D9610 |
|
16,158 |
13,352 |
$1.04M |
| 0360 |
|
1,405 |
1,340 |
$972K |
| D9420 |
|
13,934 |
13,613 |
$952K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,372 |
396 |
$652K |
| D9221 |
|
4,664 |
3,609 |
$555K |
| D4341 |
|
6,982 |
1,865 |
$478K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
4,020 |
1,151 |
$475K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,048 |
1,754 |
$467K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,910 |
4,894 |
$307K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,089 |
1,826 |
$289K |
| D1110 |
Prophylaxis - adult |
3,198 |
3,165 |
$261K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
2,155 |
736 |
$212K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,006 |
1,265 |
$200K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,039 |
6,607 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
3,418 |
3,391 |
$156K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,001 |
916 |
$133K |
| D2330 |
|
1,727 |
926 |
$132K |
| Z7506 |
|
1,327 |
1,325 |
$111K |
| D2931 |
|
893 |
541 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,791 |
951 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,272 |
7,194 |
$91K |
| D1120 |
Prophylaxis - child |
2,839 |
2,815 |
$87K |
| D1351 |
Sealant - per tooth |
3,003 |
852 |
$80K |
| D2332 |
|
845 |
552 |
$69K |
| D4910 |
|
936 |
917 |
$63K |
| D0272 |
Bitewings - two radiographic images |
5,450 |
5,400 |
$63K |
| D2140 |
|
1,153 |
639 |
$62K |
| Z7514 |
|
1,330 |
1,324 |
$46K |
| Z7500 |
|
1,307 |
1,300 |
$26K |
| Z7508 |
|
611 |
611 |
$21K |
| Z7512 |
|
1,283 |
1,277 |
$20K |
| D9993 |
|
383 |
383 |
$18K |
| D1310 |
|
383 |
383 |
$17K |
| D2954 |
|
133 |
65 |
$14K |
| D3310 |
|
46 |
24 |
$14K |
| D0350 |
|
4,996 |
3,445 |
$14K |
| D1354 |
|
483 |
357 |
$12K |
| D2335 |
|
78 |
52 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
65 |
$8K |
| D1510 |
|
41 |
24 |
$7K |
| D0603 |
|
365 |
365 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
351 |
$4K |
| D4342 |
|
39 |
14 |
$2K |
| D1999 |
|
135 |
134 |
$46.00 |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$0.00 |