| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,138 |
2,035 |
$169K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
760 |
723 |
$86K |
| D1120 |
Prophylaxis - child |
1,783 |
1,671 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,445 |
2,789 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
477 |
335 |
$31K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
293 |
290 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
621 |
577 |
$23K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
218 |
215 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,127 |
749 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
302 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
352 |
332 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,085 |
977 |
$15K |
| D1351 |
Sealant - per tooth |
343 |
129 |
$9K |
| D0274 |
Bitewings - four radiographic images |
392 |
354 |
$8K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
61 |
56 |
$6K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
366 |
313 |
$3K |
| 0071A |
|
81 |
81 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
227 |
183 |
$3K |
| 0072A |
|
70 |
70 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
38 |
$3K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
26 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
140 |
130 |
$2K |
| 0002A |
|
38 |
38 |
$1K |
| 96158 |
|
26 |
25 |
$1K |
| 90656 |
|
49 |
49 |
$1K |
| D0240 |
|
160 |
79 |
$1K |
| 96156 |
|
12 |
12 |
$832.08 |
| D9995 |
|
26 |
26 |
$829.40 |
| D0191 |
|
68 |
66 |
$793.61 |
| 90619 |
|
24 |
15 |
$527.04 |
| 36416 |
|
133 |
133 |
$518.25 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
47 |
45 |
$505.44 |
| 90670 |
|
12 |
12 |
$263.52 |
| D1354 |
|
49 |
12 |
$256.92 |
| 85018 |
|
39 |
39 |
$64.74 |
| 91307 |
|
189 |
179 |
$0.07 |
| D0603 |
|
871 |
815 |
$0.01 |
| D1310 |
|
4,531 |
3,550 |
$0.00 |
| D1330 |
|
4,558 |
3,571 |
$0.00 |
| 90480 |
|
15 |
15 |
$0.00 |
| D0602 |
|
74 |
66 |
$0.00 |