| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
112 |
81 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,394 |
1,251 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,751 |
2,027 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,149 |
2,220 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
872 |
644 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
418 |
354 |
$15K |
| D0170 |
|
267 |
221 |
$12K |
| D0364 |
|
140 |
132 |
$10K |
| D0330 |
Panoramic radiographic image |
71 |
71 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
12 |
12 |
$1K |
| D2955 |
|
14 |
13 |
$1K |