| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,623 |
1,625 |
$1.56M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,877 |
439 |
$223K |
| D9222 |
|
1,624 |
1,617 |
$198K |
| D9610 |
|
2,850 |
1,805 |
$150K |
| D9221 |
|
260 |
178 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,385 |
519 |
$91K |
| D9430 |
|
2,099 |
2,087 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,791 |
2,165 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
875 |
$56K |
| D3240 |
|
514 |
151 |
$51K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
480 |
148 |
$48K |
| D1120 |
Prophylaxis - child |
1,405 |
1,397 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
767 |
275 |
$44K |
| D9220 |
|
178 |
178 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
637 |
633 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,153 |
2,121 |
$25K |
| D0350 |
|
2,515 |
887 |
$25K |
| D0330 |
Panoramic radiographic image |
832 |
832 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,082 |
1,075 |
$13K |
| D2330 |
|
145 |
58 |
$11K |
| D1310 |
|
264 |
263 |
$7K |
| D9993 |
|
168 |
168 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
51 |
$5K |
| D1351 |
Sealant - per tooth |
102 |
37 |
$4K |
| D3230 |
|
37 |
12 |
$4K |
| D0603 |
|
221 |
221 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
150 |
150 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$918.00 |