| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,032 |
447 |
$242K |
| D2750 |
|
723 |
324 |
$218K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,919 |
2,159 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,069 |
245 |
$48K |
| D4910 |
|
1,153 |
614 |
$45K |
| D0160 |
|
1,880 |
1,073 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,459 |
1,244 |
$35K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
691 |
254 |
$31K |
| D9222 |
|
523 |
260 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
548 |
307 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,271 |
1,282 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,321 |
720 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
176 |
48 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
644 |
345 |
$8K |
| D6740 |
|
32 |
12 |
$8K |
| D4346 |
|
297 |
149 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
29 |
$5K |
| D9243 |
|
206 |
87 |
$4K |
| D4355 |
|
70 |
39 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
27 |
$3K |
| D9239 |
|
183 |
89 |
$3K |
| D9910 |
|
229 |
87 |
$2K |
| D0170 |
|
205 |
101 |
$2K |
| D2332 |
|
32 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
121 |
$756.40 |
| D4342 |
|
39 |
12 |
$729.20 |