| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,121 |
1,004 |
$338K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,069 |
889 |
$178K |
| D9222 |
|
1,056 |
1,000 |
$125K |
| D1110 |
Prophylaxis - adult |
3,317 |
3,288 |
$112K |
| D7230 |
|
650 |
320 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,408 |
751 |
$81K |
| D0274 |
Bitewings - four radiographic images |
3,107 |
3,073 |
$80K |
| D7240 |
Removal of impacted tooth - completely bony |
448 |
151 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,089 |
3,052 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,287 |
1,230 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,306 |
1,283 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,984 |
1,962 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
871 |
866 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
725 |
397 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,606 |
3,539 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,213 |
3,128 |
$24K |
| D1351 |
Sealant - per tooth |
637 |
94 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
160 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
58 |
$12K |
| D0330 |
Panoramic radiographic image |
230 |
230 |
$7K |
| D5214 |
|
12 |
12 |
$6K |
| D1120 |
Prophylaxis - child |
192 |
192 |
$5K |
| D9110 |
|
115 |
112 |
$3K |
| D4341 |
|
27 |
12 |
$2K |
| D2330 |
|
43 |
28 |
$2K |
| D1330 |
|
212 |
212 |
$1K |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$647.58 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$172.48 |