| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
2,945 |
2,920 |
$1.32M |
| D7240 |
Removal of impacted tooth - completely bony |
3,254 |
1,234 |
$1.11M |
| D7140 |
Extraction, erupted tooth or exposed root |
8,694 |
2,724 |
$875K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,152 |
1,902 |
$803K |
| D7230 |
|
1,540 |
858 |
$505K |
| D9222 |
|
1,973 |
1,957 |
$366K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,548 |
394 |
$293K |
| D9310 |
|
5,390 |
5,378 |
$254K |
| D0330 |
Panoramic radiographic image |
1,297 |
1,295 |
$68K |
| D7220 |
|
501 |
295 |
$62K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
626 |
248 |
$54K |
| D9420 |
|
586 |
586 |
$51K |
| D9610 |
|
2,757 |
2,735 |
$48K |
| D1120 |
Prophylaxis - child |
510 |
510 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
275 |
272 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
586 |
586 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
315 |
315 |
$11K |
| D0272 |
Bitewings - two radiographic images |
445 |
445 |
$9K |
| D1206 |
Topical application of fluoride varnish |
268 |
268 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
40 |
37 |
$6K |
| D1351 |
Sealant - per tooth |
133 |
44 |
$5K |
| D2933 |
|
39 |
15 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
297 |
$3K |
| D2330 |
|
40 |
26 |
$2K |
| D9110 |
|
69 |
69 |
$2K |
| D0240 |
|
14 |
14 |
$238.00 |
| D9995 |
|
60 |
60 |
$0.00 |