| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
220 |
174 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,413 |
1,321 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
524 |
267 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
854 |
696 |
$29K |
| D0330 |
Panoramic radiographic image |
1,000 |
908 |
$24K |
| D3348 |
|
50 |
45 |
$23K |
| D4341 |
|
136 |
42 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
120 |
78 |
$8K |
| D9430 |
|
176 |
172 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,266 |
731 |
$4K |
| D1110 |
Prophylaxis - adult |
57 |
53 |
$3K |
| D1120 |
Prophylaxis - child |
100 |
93 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
84 |
80 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
175 |
159 |
$2K |
| D0274 |
Bitewings - four radiographic images |
90 |
88 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
29 |
15 |
$928.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$918.40 |
| D0270 |
|
178 |
172 |
$870.00 |
| D0272 |
Bitewings - two radiographic images |
78 |
65 |
$690.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$78.00 |
| D0140 |
Limited oral evaluation - problem focused |
369 |
315 |
$0.00 |