| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
582 |
546 |
$269K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,917 |
1,171 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,405 |
2,397 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
2,370 |
2,362 |
$113K |
| D9430 |
|
3,091 |
3,036 |
$97K |
| D7240 |
Removal of impacted tooth - completely bony |
199 |
86 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,636 |
2,616 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,094 |
2,479 |
$25K |
| D3320 |
|
16 |
14 |
$6K |
| D9110 |
|
38 |
37 |
$2K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$990.00 |