| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
3,730 |
761 |
$881K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
3,206 |
597 |
$378K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
1,397 |
427 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,636 |
472 |
$92K |
| D9222 |
|
768 |
758 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
1,020 |
$67K |
| D1120 |
Prophylaxis - child |
1,315 |
1,312 |
$64K |
| D9610 |
|
1,907 |
756 |
$63K |
| D1310 |
|
805 |
803 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
471 |
216 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
393 |
393 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,275 |
1,274 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,787 |
1,473 |
$26K |
| D7963 |
|
110 |
76 |
$25K |
| D0350 |
|
2,964 |
830 |
$25K |
| D2335 |
|
205 |
68 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
297 |
140 |
$15K |
| D1510 |
|
71 |
47 |
$14K |
| D0272 |
Bitewings - two radiographic images |
946 |
942 |
$11K |
| D2330 |
|
132 |
61 |
$10K |
| D0603 |
|
783 |
782 |
$10K |
| D2332 |
|
120 |
54 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
108 |
108 |
$8K |
| D3230 |
|
57 |
19 |
$6K |
| D9430 |
|
90 |
89 |
$3K |
| D1351 |
Sealant - per tooth |
74 |
26 |
$3K |
| D9920 |
|
37 |
37 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
30 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
39 |
$480.00 |