| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,085 |
1,085 |
$54K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
513 |
336 |
$47K |
| D9222 |
|
338 |
337 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
917 |
917 |
$35K |
| D2950 |
|
247 |
144 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,102 |
1,102 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
844 |
844 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,487 |
1,453 |
$19K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
31 |
27 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
377 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
75 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
588 |
588 |
$10K |
| D0330 |
Panoramic radiographic image |
203 |
203 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
438 |
343 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
12 |
$3K |