| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
1,364 |
1,349 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
542 |
540 |
$35K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
25 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
221 |
218 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,732 |
706 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
86 |
55 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
162 |
162 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
584 |
579 |
$7K |
| D1120 |
Prophylaxis - child |
117 |
116 |
$4K |
| D0330 |
Panoramic radiographic image |
65 |
64 |
$2K |
| D0274 |
Bitewings - four radiographic images |
80 |
80 |
$2K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
81 |
77 |
$948.00 |