| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,508 |
1,367 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
1,507 |
1,376 |
$58K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,650 |
4,295 |
$55K |
| D1206 |
Topical application of fluoride varnish |
1,502 |
1,364 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
234 |
$18K |
| D0274 |
Bitewings - four radiographic images |
596 |
541 |
$13K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
716 |
656 |
$11K |
| D2140 |
|
228 |
183 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
194 |
126 |
$10K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
342 |
322 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
354 |
310 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
281 |
258 |
$6K |
| S4993 |
Contraceptive pills for birth control |
198 |
152 |
$6K |
| D1110 |
Prophylaxis - adult |
116 |
88 |
$6K |
| 99201 |
|
346 |
313 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
101 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
567 |
502 |
$4K |
| D1351 |
Sealant - per tooth |
78 |
31 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
93 |
$2K |
| 96127 |
|
135 |
117 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
39 |
39 |
$1K |
| D0272 |
Bitewings - two radiographic images |
100 |
97 |
$1K |
| H1000 |
Prenatal care, at-risk assessment |
30 |
27 |
$379.60 |
| 36416 |
|
78 |
70 |
$319.03 |
| D0270 |
|
13 |
13 |
$72.80 |
| 85018 |
|
31 |
22 |
$71.92 |