| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
466 |
439 |
$226K |
| D9310 |
|
1,880 |
1,879 |
$134K |
| D2954 |
|
186 |
127 |
$31K |
| D0330 |
Panoramic radiographic image |
674 |
673 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
711 |
707 |
$11K |
| D0272 |
Bitewings - two radiographic images |
475 |
475 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
498 |
493 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
191 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
248 |
$3K |
| D9110 |
|
12 |
12 |
$220.82 |
| D9430 |
|
15 |
14 |
$0.00 |