| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
4,646 |
1,199 |
$1.15M |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,423 |
1,557 |
$625K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
3,196 |
1,077 |
$308K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,783 |
2,005 |
$307K |
| D1120 |
Prophylaxis - child |
5,991 |
5,939 |
$291K |
| D0120 |
Periodic oral evaluation - established patient |
3,699 |
3,662 |
$276K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,182 |
1,681 |
$270K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,810 |
3,793 |
$250K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,903 |
1,693 |
$213K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42,454 |
8,713 |
$182K |
| D9222 |
|
1,191 |
1,189 |
$146K |
| D1510 |
|
680 |
532 |
$138K |
| D1310 |
|
2,879 |
2,861 |
$125K |
| D9610 |
|
2,503 |
1,247 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,810 |
5,756 |
$100K |
| D2390 |
|
962 |
348 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,371 |
2,336 |
$94K |
| D1351 |
Sealant - per tooth |
2,124 |
656 |
$78K |
| D0272 |
Bitewings - two radiographic images |
6,264 |
6,226 |
$74K |
| D2330 |
|
858 |
295 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
3,866 |
3,757 |
$44K |
| D0350 |
|
5,691 |
2,352 |
$39K |
| D2932 |
|
376 |
132 |
$38K |
| D0145 |
Oral evaluation for a patient under three years of age |
498 |
498 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
368 |
235 |
$29K |
| D0603 |
|
1,836 |
1,825 |
$25K |
| D9430 |
|
689 |
668 |
$22K |
| D0601 |
|
881 |
874 |
$13K |
| D9243 |
|
340 |
138 |
$11K |
| D1206 |
Topical application of fluoride varnish |
351 |
349 |
$10K |
| D9239 |
|
137 |
137 |
$4K |
| D2331 |
|
38 |
13 |
$2K |
| D9993 |
|
2,877 |
2,859 |
$0.00 |