| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,312 |
1,259 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,598 |
2,418 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
890 |
842 |
$25K |
| D0274 |
Bitewings - four radiographic images |
900 |
827 |
$24K |
| D1110 |
Prophylaxis - adult |
866 |
793 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,220 |
2,011 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,304 |
1,249 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
920 |
880 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
509 |
482 |
$12K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
283 |
270 |
$8K |
| 99348 |
|
138 |
128 |
$6K |
| D0272 |
Bitewings - two radiographic images |
262 |
233 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
175 |
173 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
73 |
72 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
90 |
90 |
$1K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
14 |
$569.80 |
| 92552 |
|
59 |
59 |
$383.50 |
| 99173 |
|
60 |
60 |
$337.20 |
| 90715 |
|
46 |
46 |
$154.75 |
| D0190 |
|
260 |
245 |
$0.08 |
| D0603 |
|
913 |
810 |
$0.00 |
| D1330 |
|
1,598 |
1,464 |
$0.00 |
| D0602 |
|
131 |
125 |
$0.00 |
| 90651 |
|
16 |
16 |
$0.00 |
| D1310 |
|
32 |
31 |
$0.00 |
| 90734 |
|
126 |
126 |
$0.00 |