| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
16,903 |
16,442 |
$413K |
| D1120 |
Prophylaxis - child |
12,304 |
12,284 |
$340K |
| D0120 |
Periodic oral evaluation - established patient |
13,633 |
13,602 |
$322K |
| D1999 |
|
16,104 |
15,454 |
$160K |
| D1110 |
Prophylaxis - adult |
4,137 |
4,126 |
$149K |
| D0274 |
Bitewings - four radiographic images |
8,200 |
8,181 |
$126K |
| D1351 |
Sealant - per tooth |
5,277 |
2,025 |
$124K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,609 |
1,285 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,985 |
1,984 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,970 |
2,718 |
$82K |
| D2140 |
|
1,104 |
905 |
$58K |
| D0272 |
Bitewings - two radiographic images |
4,370 |
4,362 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
670 |
401 |
$49K |
| 90651 |
|
1,957 |
1,922 |
$43K |
| 90686 |
|
3,807 |
3,746 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,501 |
1,499 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,420 |
1,411 |
$34K |
| 90670 |
|
2,149 |
2,129 |
$33K |
| 90746 |
|
996 |
974 |
$33K |
| 90633 |
|
2,846 |
2,804 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
274 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
703 |
702 |
$28K |
| 90716 |
|
1,224 |
1,200 |
$27K |
| D1354 |
|
2,401 |
729 |
$25K |
| D0330 |
Panoramic radiographic image |
2,793 |
2,784 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,648 |
1,609 |
$22K |
| 90715 |
|
1,608 |
1,581 |
$21K |
| 90744 |
|
1,641 |
1,614 |
$18K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,020 |
999 |
$17K |
| 90698 |
|
1,136 |
1,125 |
$14K |
| 90713 |
|
1,076 |
1,057 |
$13K |
| 90707 |
|
939 |
926 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,335 |
2,319 |
$13K |
| D2160 |
|
135 |
118 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
92 |
80 |
$10K |
| 90734 |
|
866 |
848 |
$10K |
| 90680 |
|
767 |
765 |
$10K |
| 90714 |
|
966 |
943 |
$9K |
| 90710 |
|
657 |
645 |
$7K |
| 90696 |
|
558 |
553 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
731 |
719 |
$6K |
| 90700 |
|
459 |
453 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
67 |
$5K |
| 90685 |
|
385 |
383 |
$4K |
| 90648 |
|
212 |
211 |
$3K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
83 |
83 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
505 |
381 |
$2K |
| 91321 |
|
53 |
53 |
$2K |
| 91322 |
|
146 |
146 |
$1K |
| 90723 |
|
91 |
90 |
$1K |
| 90688 |
|
60 |
59 |
$1K |
| 90619 |
|
156 |
149 |
$1K |
| 91319 |
|
45 |
45 |
$992.04 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
51 |
49 |
$778.05 |
| 90677 |
|
56 |
56 |
$602.10 |
| D7111 |
|
16 |
12 |
$572.00 |
| 90620 |
|
61 |
58 |
$491.40 |
| 36415 |
Collection of venous blood by venipuncture |
70 |
65 |
$445.01 |
| 91318 |
|
12 |
12 |
$386.10 |
| 91320 |
|
37 |
37 |
$308.54 |
| D0270 |
|
29 |
28 |
$252.19 |
| 86703 |
|
35 |
30 |
$173.69 |
| 99383 |
|
64 |
54 |
$113.85 |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
29 |
15 |
$35.09 |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
29 |
15 |
$35.09 |
| 86780 |
|
16 |
15 |
$13.24 |
| D1330 |
|
226 |
226 |
$0.00 |
| D0603 |
|
40 |
40 |
$0.00 |
| 36416 |
|
12 |
12 |
$0.00 |
| S9445 |
Patient education, not otherwise classified, non-physician provider, individual, per session |
15 |
13 |
$0.00 |
| 99001 |
|
81 |
81 |
$0.00 |
| T1001 |
Nursing assessment / evaluation |
609 |
594 |
$0.00 |