| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
130 |
118 |
$59K |
| D9430 |
|
589 |
575 |
$19K |
| D0274 |
Bitewings - four radiographic images |
400 |
399 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
63 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,148 |
419 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
71 |
37 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |