| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
7,368 |
6,561 |
$674K |
| T1015 |
Clinic visit/encounter, all-inclusive |
5,119 |
2,743 |
$496K |
| D0120 |
Periodic oral evaluation - established patient |
3,281 |
3,121 |
$8K |
| D0274 |
Bitewings - four radiographic images |
701 |
663 |
$4K |
| D0272 |
Bitewings - two radiographic images |
1,058 |
1,011 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
273 |
231 |
$4K |
| 0124A |
|
85 |
82 |
$4K |
| 0064A |
|
68 |
68 |
$3K |
| 0001A |
|
63 |
63 |
$3K |
| 0002A |
|
60 |
57 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
959 |
908 |
$2K |
| D1120 |
Prophylaxis - child |
3,581 |
3,421 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
105 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,249 |
1,124 |
$2K |
| 0072A |
|
43 |
43 |
$2K |
| 0012A |
|
40 |
36 |
$2K |
| 0004A |
|
32 |
32 |
$1K |
| 90686 |
|
229 |
190 |
$1K |
| 0071A |
|
28 |
28 |
$1K |
| D1206 |
Topical application of fluoride varnish |
2,770 |
2,646 |
$991.64 |
| 0011A |
|
13 |
12 |
$522.62 |
| D1351 |
Sealant - per tooth |
424 |
202 |
$107.64 |
| D0230 |
Intraoral - periapical each additional radiographic image |
458 |
397 |
$64.60 |
| 90670 |
|
63 |
36 |
$31.66 |
| 81025 |
|
28 |
28 |
$10.34 |
| 81002 |
|
332 |
131 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
489 |
297 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
71 |
56 |
$0.00 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
62 |
25 |
$0.00 |
| 0502F |
|
427 |
216 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
240 |
146 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
138 |
74 |
$0.00 |
| H0050 |
Alcohol and/or drug services, brief intervention, per 15 minutes |
190 |
96 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
144 |
71 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,776 |
1,026 |
$0.00 |
| 96127 |
|
1,659 |
698 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
953 |
690 |
$0.00 |
| G8420 |
Bmi is documented within normal parameters and no follow-up plan is required |
114 |
62 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
467 |
312 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
26 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
801 |
445 |
$0.00 |
| 3008F |
|
1,138 |
705 |
$0.00 |
| 82962 |
|
56 |
12 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
35 |
34 |
$0.00 |
| S5190 |
Wellness assessment, performed by non-physician |
60 |
55 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$0.00 |