| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9243 |
|
979 |
899 |
$454K |
| D4342 |
|
3,307 |
750 |
$450K |
| D2740 |
Crown - porcelain/ceramic |
587 |
269 |
$401K |
| D1110 |
Prophylaxis - adult |
3,482 |
3,312 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
4,601 |
4,279 |
$155K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
307 |
303 |
$141K |
| D9239 |
|
921 |
893 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
931 |
195 |
$89K |
| D9222 |
|
326 |
324 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
547 |
495 |
$48K |
| D4910 |
|
401 |
334 |
$38K |
| D0274 |
Bitewings - four radiographic images |
586 |
536 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,077 |
1,016 |
$17K |
| D9219 |
|
256 |
251 |
$11K |
| D1206 |
Topical application of fluoride varnish |
263 |
220 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
295 |
276 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
102 |
96 |
$4K |
| D2950 |
|
21 |
13 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
52 |
$2K |