| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,517 |
3,440 |
$232K |
| D1206 |
Topical application of fluoride varnish |
3,755 |
3,667 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
3,142 |
3,026 |
$140K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12,046 |
10,205 |
$134K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,332 |
3,243 |
$54K |
| 83655 |
|
3,335 |
3,213 |
$39K |
| 96127 |
|
2,680 |
2,563 |
$38K |
| H1000 |
Prenatal care, at-risk assessment |
1,868 |
1,804 |
$27K |
| 90715 |
|
1,565 |
1,407 |
$26K |
| 90670 |
|
2,020 |
1,912 |
$24K |
| 90723 |
|
1,937 |
1,786 |
$21K |
| 90647 |
|
1,957 |
1,777 |
$21K |
| 90682 |
|
399 |
327 |
$20K |
| D1351 |
Sealant - per tooth |
92 |
69 |
$19K |
| 90734 |
|
1,244 |
1,174 |
$19K |
| 90716 |
|
550 |
514 |
$18K |
| 90633 |
|
1,597 |
1,490 |
$17K |
| 90651 |
|
856 |
780 |
$17K |
| D0274 |
Bitewings - four radiographic images |
588 |
577 |
$16K |
| D0272 |
Bitewings - two radiographic images |
926 |
901 |
$14K |
| D0330 |
Panoramic radiographic image |
376 |
373 |
$13K |
| 36416 |
|
3,315 |
3,200 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
345 |
$13K |
| 90710 |
|
827 |
732 |
$12K |
| 90619 |
|
756 |
696 |
$12K |
| 0012A |
|
315 |
304 |
$12K |
| 0001A |
|
281 |
271 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
99 |
$11K |
| 90686 |
|
949 |
890 |
$11K |
| 0002A |
|
252 |
246 |
$11K |
| 86580 |
|
2,388 |
1,606 |
$10K |
| 0011A |
|
320 |
312 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
132 |
$10K |
| 90707 |
|
499 |
471 |
$9K |
| 90677 |
|
340 |
290 |
$9K |
| 90680 |
|
799 |
752 |
$8K |
| 90696 |
|
536 |
483 |
$6K |
| D1354 |
|
74 |
73 |
$6K |
| 0031A |
|
112 |
112 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
177 |
163 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
459 |
428 |
$3K |
| 0064A |
|
69 |
62 |
$3K |
| 90700 |
|
283 |
269 |
$3K |
| 99402 |
|
87 |
76 |
$2K |
| 0124A |
|
31 |
30 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$1K |
| 90656 |
|
56 |
44 |
$1K |
| 0004A |
|
26 |
26 |
$1K |
| 90620 |
|
26 |
25 |
$992.69 |
| 0072A |
|
37 |
35 |
$987.34 |
| 90685 |
|
129 |
126 |
$963.00 |
| 0071A |
|
36 |
34 |
$945.20 |
| 90681 |
|
50 |
44 |
$818.79 |
| 0134A |
|
16 |
16 |
$668.80 |
| 85018 |
|
211 |
196 |
$499.02 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
20 |
20 |
$292.00 |
| 90713 |
|
13 |
13 |
$217.23 |