| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,022 |
3,822 |
$610K |
| 99403 |
|
2,663 |
2,537 |
$404K |
| D0120 |
Periodic oral evaluation - established patient |
1,228 |
777 |
$143K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
813 |
691 |
$98K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
412 |
402 |
$64K |
| 99402 |
|
400 |
359 |
$40K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,746 |
5,213 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
327 |
276 |
$28K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,631 |
3,132 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
355 |
204 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,470 |
1,407 |
$18K |
| 99385 |
|
110 |
108 |
$17K |
| D0191 |
|
436 |
417 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
528 |
470 |
$15K |
| D1351 |
Sealant - per tooth |
1,078 |
388 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
85 |
$10K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
75 |
68 |
$9K |
| D1120 |
Prophylaxis - child |
811 |
786 |
$7K |
| D0274 |
Bitewings - four radiographic images |
359 |
333 |
$5K |
| 90715 |
|
1,468 |
1,322 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
316 |
267 |
$2K |
| D0272 |
Bitewings - two radiographic images |
349 |
337 |
$1K |
| 90696 |
|
432 |
396 |
$1K |
| D1330 |
|
1,495 |
1,429 |
$1K |
| 90710 |
|
1,028 |
936 |
$1K |
| 90686 |
|
346 |
291 |
$828.40 |
| 90633 |
|
491 |
452 |
$806.90 |
| 90651 |
|
707 |
652 |
$737.00 |
| 90670 |
|
324 |
286 |
$543.40 |
| D9999 |
Unspecified adjunctive procedure, by report |
28 |
28 |
$440.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
13 |
$398.62 |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
32 |
$353.18 |
| 90734 |
|
325 |
296 |
$329.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$312.50 |
| 90723 |
|
46 |
46 |
$287.50 |
| 90700 |
|
70 |
51 |
$225.00 |
| 90698 |
|
12 |
12 |
$158.50 |
| D1110 |
Prophylaxis - adult |
224 |
205 |
$60.64 |
| 90713 |
|
168 |
146 |
$60.50 |
| 90647 |
|
55 |
55 |
$55.00 |
| 90744 |
|
97 |
93 |
$38.50 |
| 90716 |
|
221 |
204 |
$5.50 |
| 90671 |
|
105 |
87 |
$0.01 |
| 90707 |
|
15 |
15 |
$0.00 |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$0.00 |
| 90619 |
|
39 |
39 |
$0.00 |