| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
2,965 |
2,368 |
$445K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,700 |
1,605 |
$255K |
| 99403 |
|
1,725 |
1,631 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
4,082 |
4,063 |
$217K |
| D1110 |
Prophylaxis - adult |
2,413 |
2,399 |
$185K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,023 |
1,483 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,825 |
1,811 |
$110K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
548 |
531 |
$81K |
| D1351 |
Sealant - per tooth |
5,302 |
1,517 |
$79K |
| D1120 |
Prophylaxis - child |
4,151 |
4,119 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,398 |
1,148 |
$73K |
| D0220 |
Intraoral - periapical first radiographic image |
4,473 |
4,366 |
$66K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
426 |
382 |
$60K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,028 |
4,887 |
$28K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,071 |
1,008 |
$24K |
| D0191 |
|
1,005 |
993 |
$23K |
| D1206 |
Topical application of fluoride varnish |
6,589 |
6,544 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
1,076 |
1,049 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
167 |
167 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
116 |
96 |
$11K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,815 |
1,645 |
$11K |
| D1330 |
|
6,800 |
6,753 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
139 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,520 |
2,501 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,531 |
3,437 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,400 |
1,393 |
$4K |
| 99385 |
|
24 |
24 |
$4K |
| 90686 |
|
1,261 |
1,241 |
$2K |
| D1999 |
|
23 |
23 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
50 |
50 |
$1K |
| 90715 |
|
436 |
402 |
$682.00 |
| D7111 |
|
14 |
12 |
$530.64 |
| 90651 |
|
87 |
86 |
$137.50 |
| 90633 |
|
49 |
48 |
$132.00 |
| 90710 |
|
92 |
91 |
$126.50 |
| 90696 |
|
13 |
13 |
$11.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
23 |
23 |
$0.00 |
| D9986 |
|
1,172 |
1,141 |
$0.00 |
| 90661 |
|
98 |
98 |
$0.00 |
| 90734 |
|
59 |
58 |
$0.00 |
| 90671 |
|
66 |
66 |
$0.00 |