| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
18,422 |
16,117 |
$1.08M |
| D1206 |
Topical application of fluoride varnish |
18,487 |
16,277 |
$677K |
| D1351 |
Sealant - per tooth |
6,164 |
3,321 |
$521K |
| D0120 |
Periodic oral evaluation - established patient |
12,785 |
10,961 |
$471K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,865 |
2,860 |
$296K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
7,388 |
7,064 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,389 |
1,809 |
$111K |
| D1354 |
|
1,567 |
1,016 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,893 |
2,547 |
$74K |
| D0272 |
Bitewings - two radiographic images |
5,172 |
4,583 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,761 |
1,567 |
$54K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,082 |
938 |
$49K |
| 92551 |
|
3,077 |
3,052 |
$47K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,669 |
3,159 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
269 |
$31K |
| 96127 |
|
1,796 |
1,745 |
$26K |
| 99173 |
|
2,879 |
2,851 |
$21K |
| H1000 |
Prenatal care, at-risk assessment |
1,099 |
1,060 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
170 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,668 |
1,460 |
$14K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
196 |
147 |
$11K |
| 90686 |
|
730 |
646 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
75 |
51 |
$8K |
| 81025 |
|
1,411 |
1,134 |
$6K |
| 91322 |
|
44 |
44 |
$5K |
| 90734 |
|
160 |
130 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
123 |
109 |
$3K |
| 99201 |
|
93 |
86 |
$3K |
| 83655 |
|
193 |
176 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
228 |
186 |
$2K |
| 90651 |
|
62 |
49 |
$2K |
| 87210 |
|
485 |
429 |
$2K |
| 36416 |
|
388 |
283 |
$1K |
| 90715 |
|
67 |
49 |
$927.64 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
14 |
14 |
$820.16 |
| 90716 |
|
54 |
42 |
$710.09 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
462 |
354 |
$647.20 |
| 90632 |
|
73 |
61 |
$623.92 |
| 90707 |
|
40 |
39 |
$619.04 |
| 85018 |
|
290 |
214 |
$597.40 |
| 96160 |
|
35 |
35 |
$511.00 |
| 90633 |
|
22 |
22 |
$437.80 |
| 90656 |
|
21 |
18 |
$412.39 |
| 90619 |
|
23 |
18 |
$384.33 |
| 90670 |
|
35 |
31 |
$328.82 |
| 90648 |
|
28 |
26 |
$273.70 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$194.40 |
| 90723 |
|
12 |
12 |
$146.68 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
741 |
587 |
$45.80 |
| D0601 |
|
1,560 |
925 |
$0.75 |
| 90461 |
|
133 |
117 |
$0.00 |
| 86593 |
|
397 |
346 |
$0.00 |
| D0602 |
|
563 |
372 |
$0.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
414 |
360 |
$0.00 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
740 |
586 |
$0.00 |
| D0603 |
|
590 |
389 |
$0.00 |
| 86780 |
|
29 |
23 |
$0.00 |
| D1330 |
|
126 |
121 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
60 |
57 |
$0.00 |