| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99232 |
Subsequent hospital care, per day, moderate complexity |
5,132 |
2,190 |
$259K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
847 |
151 |
$145K |
| 99233 |
Prolong inpt eval add15 m |
2,007 |
885 |
$137K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,126 |
2,053 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
534 |
127 |
$48K |
| D1120 |
Prophylaxis - child |
576 |
528 |
$24K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
359 |
358 |
$24K |
| D1206 |
Topical application of fluoride varnish |
854 |
790 |
$20K |
| S0302 |
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service) |
2,049 |
2,041 |
$19K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
1,855 |
1,844 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
264 |
257 |
$17K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
156 |
156 |
$12K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
168 |
157 |
$10K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
144 |
144 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
295 |
293 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
131 |
126 |
$7K |
| 00170 |
Anesthesia for intraoral procedures, including biopsy |
55 |
55 |
$7K |
| D1110 |
Prophylaxis - adult |
103 |
103 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
625 |
133 |
$5K |
| D0272 |
Bitewings - two radiographic images |
166 |
166 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
100 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
223 |
210 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
122 |
122 |
$3K |
| D1351 |
Sealant - per tooth |
66 |
18 |
$3K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
34 |
28 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
28 |
$660.00 |
| D9430 |
|
12 |
12 |
$0.00 |