| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
19,203 |
15,267 |
$2.76M |
| D0330 |
Panoramic radiographic image |
1,850 |
1,807 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
3,141 |
3,072 |
$153K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,981 |
1,904 |
$124K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,585 |
1,377 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,925 |
1,900 |
$104K |
| D1110 |
Prophylaxis - adult |
1,834 |
1,795 |
$83K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
689 |
625 |
$62K |
| D2160 |
|
553 |
327 |
$52K |
| 99403 |
|
299 |
288 |
$40K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
644 |
403 |
$39K |
| D1351 |
Sealant - per tooth |
8,735 |
2,031 |
$36K |
| D1120 |
Prophylaxis - child |
4,003 |
3,811 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
477 |
304 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
774 |
560 |
$30K |
| D0191 |
|
707 |
569 |
$21K |
| D1206 |
Topical application of fluoride varnish |
6,035 |
5,799 |
$20K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,466 |
1,848 |
$12K |
| 99215 |
Prolong outpt/office vis |
115 |
95 |
$11K |
| 99443 |
|
874 |
597 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
999 |
925 |
$10K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,933 |
2,657 |
$10K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
97 |
90 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,611 |
2,510 |
$6K |
| D1330 |
|
6,045 |
5,808 |
$5K |
| D0272 |
Bitewings - two radiographic images |
2,668 |
2,610 |
$5K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
41 |
37 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,515 |
1,494 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
220 |
208 |
$4K |
| D1999 |
|
38 |
38 |
$2K |
| 90715 |
|
497 |
449 |
$2K |
| D2140 |
|
52 |
37 |
$2K |
| 90651 |
|
553 |
500 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,219 |
1,182 |
$1K |
| 90633 |
|
539 |
501 |
$957.00 |
| 90696 |
|
137 |
132 |
$819.50 |
| 90734 |
|
367 |
325 |
$352.00 |
| 90686 |
|
210 |
198 |
$341.47 |
| 90710 |
|
395 |
370 |
$297.00 |
| 99442 |
|
43 |
30 |
$271.18 |
| 90723 |
|
38 |
30 |
$198.00 |
| 90670 |
|
99 |
84 |
$93.50 |
| 90648 |
|
63 |
50 |
$82.50 |
| 90620 |
|
44 |
41 |
$71.50 |
| 81002 |
|
96 |
82 |
$70.14 |
| 90713 |
|
133 |
126 |
$55.00 |
| 90744 |
|
94 |
89 |
$44.00 |
| 90716 |
|
81 |
78 |
$0.00 |
| 90619 |
|
68 |
66 |
$0.00 |
| 90656 |
|
26 |
26 |
$0.00 |
| 90671 |
|
30 |
28 |
$0.00 |
| 90707 |
|
13 |
12 |
$0.00 |