| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
25,879 |
21,069 |
$5.70M |
| D1206 |
Topical application of fluoride varnish |
18,200 |
15,312 |
$342K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
2,309 |
2,137 |
$125K |
| D0190 |
|
4,665 |
4,208 |
$123K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
834 |
123 |
$107K |
| D1120 |
Prophylaxis - child |
2,568 |
2,113 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,376 |
2,762 |
$99K |
| 99239 |
Hospital discharge day management, more than 30 minutes |
836 |
792 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,379 |
1,070 |
$60K |
| D0272 |
Bitewings - two radiographic images |
1,780 |
1,426 |
$49K |
| H1005 |
Prenatal care, at-risk enhanced service package (includes h1001-h1004) |
130 |
99 |
$42K |
| D0330 |
Panoramic radiographic image |
577 |
442 |
$32K |
| D0145 |
Oral evaluation for a patient under three years of age |
956 |
800 |
$29K |
| D0274 |
Bitewings - four radiographic images |
758 |
595 |
$29K |
| 99460 |
|
278 |
250 |
$22K |
| D1351 |
Sealant - per tooth |
792 |
214 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,045 |
831 |
$19K |
| D9420 |
|
141 |
140 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
40 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
525 |
443 |
$12K |
| 59409 |
Vaginal delivery only (with or without episiotomy and/or forceps) |
14 |
13 |
$9K |
| D1110 |
Prophylaxis - adult |
192 |
151 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
42 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
199 |
164 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
27 |
27 |
$5K |
| D1354 |
|
407 |
112 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
105 |
$3K |
| D1353 |
|
102 |
41 |
$3K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
47 |
37 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
12 |
$2K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
30 |
17 |
$526.83 |
| 99462 |
|
14 |
12 |
$443.28 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$144.00 |