| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
521 |
513 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
34 |
32 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
108 |
108 |
$7K |
| D0274 |
Bitewings - four radiographic images |
311 |
308 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
282 |
263 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
704 |
401 |
$3K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$930.00 |
| D1320 |
|
41 |
41 |
$710.00 |