| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,190 |
1,145 |
$57K |
| D1120 |
Prophylaxis - child |
2,260 |
2,086 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,617 |
1,537 |
$31K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
799 |
672 |
$30K |
| 90834 |
Psychotherapy, 45 minutes with patient |
493 |
368 |
$24K |
| D1110 |
Prophylaxis - adult |
952 |
899 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,857 |
1,807 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
463 |
366 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
449 |
358 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,305 |
1,399 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,246 |
1,201 |
$11K |
| 90791 |
Psychiatric diagnostic evaluation |
138 |
111 |
$9K |
| D1330 |
|
3,713 |
3,491 |
$9K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
401 |
330 |
$7K |
| 90832 |
Psychotherapy, 30 minutes with patient |
177 |
139 |
$7K |
| D0330 |
Panoramic radiographic image |
287 |
286 |
$6K |
| D1206 |
Topical application of fluoride varnish |
3,855 |
3,598 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
999 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
96 |
90 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,255 |
2,136 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
40 |
39 |
$2K |
| D4346 |
|
138 |
136 |
$2K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
20 |
18 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$574.15 |
| D2331 |
|
16 |
12 |
$463.36 |
| D0272 |
Bitewings - two radiographic images |
240 |
239 |
$445.68 |
| D0270 |
|
83 |
83 |
$137.30 |
| D4342 |
|
21 |
12 |
$68.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
15 |
15 |
$56.00 |
| 3074F |
|
788 |
681 |
$25.00 |
| 3078F |
|
669 |
582 |
$21.75 |
| 3044F |
|
120 |
115 |
$0.00 |
| 1220F |
|
1,428 |
1,105 |
$0.00 |
| 3079F |
|
203 |
186 |
$0.00 |
| 1000F |
|
1,276 |
1,017 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
35 |
32 |
$0.00 |
| 1125F |
|
280 |
245 |
$0.00 |
| 3008F |
|
1,118 |
965 |
$0.00 |
| 2001F |
|
1,077 |
925 |
$0.00 |
| 2000F |
|
1,063 |
914 |
$0.00 |
| D1351 |
Sealant - per tooth |
35 |
12 |
$0.00 |
| 1126F |
|
574 |
508 |
$0.00 |
| D1310 |
|
170 |
170 |
$0.00 |
| 4000F |
|
87 |
80 |
$0.00 |
| 3080F |
|
16 |
15 |
$0.00 |
| 3075F |
|
51 |
47 |
$0.00 |
| 1160F |
|
638 |
565 |
$0.00 |
| 1159F |
|
639 |
565 |
$0.00 |
| D0190 |
|
157 |
156 |
$0.00 |
| 4004F |
|
15 |
13 |
$0.00 |
| 3077F |
|
31 |
29 |
$0.00 |