| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
727 |
682 |
$335K |
| D9430 |
|
3,223 |
3,070 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,549 |
1,537 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,571 |
2,548 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
406 |
238 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
727 |
727 |
$34K |
| D3348 |
|
73 |
71 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,484 |
3,030 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
39 |
28 |
$19K |
| D3221 |
|
209 |
190 |
$13K |
| D0330 |
Panoramic radiographic image |
442 |
442 |
$13K |
| D1320 |
|
303 |
303 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
38 |
$5K |
| D2954 |
|
43 |
25 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
39 |
39 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
131 |
$2K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$176.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$161.00 |
| D0350 |
|
14 |
13 |
$134.40 |
| D0140 |
Limited oral evaluation - problem focused |
88 |
88 |
$0.00 |