| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
622 |
$41K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
86 |
79 |
$40K |
| D2791 |
|
36 |
33 |
$17K |
| D2954 |
|
128 |
108 |
$13K |
| D9430 |
|
345 |
327 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
243 |
237 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,841 |
794 |
$7K |
| D0350 |
|
643 |
294 |
$6K |
| D3221 |
|
66 |
49 |
$4K |
| D0274 |
Bitewings - four radiographic images |
197 |
195 |
$4K |
| D1120 |
Prophylaxis - child |
111 |
108 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
60 |
60 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
144 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$624.00 |
| D0270 |
|
97 |
97 |
$455.00 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$422.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
35 |
33 |
$316.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$259.00 |