| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,384 |
1,298 |
$639K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,505 |
2,490 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
2,162 |
2,150 |
$99K |
| D3320 |
|
223 |
198 |
$81K |
| D9430 |
|
964 |
852 |
$31K |
| D1320 |
|
878 |
878 |
$13K |
| D3310 |
|
42 |
39 |
$13K |
| D0330 |
Panoramic radiographic image |
166 |
164 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,069 |
208 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
382 |
361 |
$4K |
| D2954 |
|
23 |
12 |
$2K |
| D3221 |
|
30 |
28 |
$2K |
| D0274 |
Bitewings - four radiographic images |
72 |
72 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
16 |
15 |
$835.00 |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$408.50 |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$372.00 |