| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
210 |
186 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,557 |
1,553 |
$85K |
| D1110 |
Prophylaxis - adult |
642 |
640 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,145 |
2,965 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,595 |
2,503 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
414 |
198 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
832 |
826 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,564 |
1,560 |
$18K |
| D1120 |
Prophylaxis - child |
441 |
439 |
$13K |
| D2330 |
|
95 |
28 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
28 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
348 |
347 |
$4K |
| D2140 |
|
67 |
28 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
13 |
$2K |
| D9430 |
|
42 |
39 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$918.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
17 |
$595.00 |