| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
391 |
186 |
$124K |
| D3320 |
|
129 |
52 |
$31K |
| D0330 |
Panoramic radiographic image |
987 |
531 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
393 |
139 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
77 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
667 |
379 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,731 |
911 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
721 |
395 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
292 |
141 |
$4K |
| D2950 |
|
339 |
134 |
$4K |
| D0274 |
Bitewings - four radiographic images |
460 |
258 |
$4K |
| D1110 |
Prophylaxis - adult |
104 |
77 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,796 |
568 |
$3K |
| D1206 |
Topical application of fluoride varnish |
144 |
92 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
15 |
$932.68 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$700.04 |
| D0120 |
Periodic oral evaluation - established patient |
14 |
14 |
$339.43 |