| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
25 |
$19K |
| D0330 |
Panoramic radiographic image |
145 |
145 |
$13K |
| D3320 |
|
17 |
13 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
42 |
$9K |
| D2950 |
|
56 |
43 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
35 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
62 |
45 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
30 |
$5K |
| D2394 |
|
37 |
28 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
95 |
95 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
106 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
212 |
$2K |
| D1320 |
|
60 |
60 |
$2K |
| D0274 |
Bitewings - four radiographic images |
56 |
56 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
99 |
$1K |
| D0270 |
|
97 |
97 |
$505.40 |