| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9310 |
|
4,506 |
4,505 |
$223K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
623 |
574 |
$187K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,836 |
1,320 |
$137K |
| D3320 |
|
533 |
493 |
$112K |
| D0210 |
Intraoral - complete series of radiographic images |
1,992 |
1,978 |
$64K |
| D1110 |
Prophylaxis - adult |
1,494 |
1,494 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,863 |
2,863 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,099 |
6,066 |
$59K |
| D0274 |
Bitewings - four radiographic images |
3,011 |
3,010 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,684 |
2,671 |
$26K |
| D3310 |
|
48 |
36 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
29 |
29 |
$317.40 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$274.32 |
| D9110 |
|
13 |
13 |
$229.52 |
| D1999 |
|
21 |
18 |
$0.00 |