| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,701 |
1,586 |
$787K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,605 |
5,599 |
$369K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,983 |
1,104 |
$236K |
| D0210 |
Intraoral - complete series of radiographic images |
3,417 |
3,415 |
$164K |
| D0330 |
Panoramic radiographic image |
2,344 |
2,341 |
$70K |
| D9430 |
|
1,780 |
1,721 |
$57K |
| D3320 |
|
124 |
113 |
$45K |
| D7230 |
|
163 |
90 |
$31K |
| D9248 |
|
673 |
668 |
$22K |
| D7240 |
Removal of impacted tooth - completely bony |
55 |
25 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
481 |
476 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
810 |
550 |
$3K |
| D1110 |
Prophylaxis - adult |
25 |
25 |
$2K |
| D0270 |
|
118 |
116 |
$590.00 |