| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
530,127 |
522,690 |
$2.63M |
| D0120 |
Periodic oral evaluation - established patient |
26,841 |
25,814 |
$789K |
| D1120 |
Prophylaxis - child |
16,067 |
15,401 |
$494K |
| D1110 |
Prophylaxis - adult |
9,968 |
9,591 |
$432K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,826 |
2,953 |
$381K |
| D1351 |
Sealant - per tooth |
12,652 |
3,936 |
$377K |
| D1206 |
Topical application of fluoride varnish |
18,884 |
18,131 |
$340K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,245 |
2,658 |
$297K |
| D2140 |
|
2,651 |
2,078 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,694 |
10,239 |
$189K |
| D0272 |
Bitewings - two radiographic images |
8,218 |
7,865 |
$170K |
| D0274 |
Bitewings - four radiographic images |
4,169 |
4,012 |
$152K |
| D0330 |
Panoramic radiographic image |
1,652 |
1,598 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,773 |
1,664 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
949 |
654 |
$73K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
969 |
854 |
$67K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,538 |
2,188 |
$63K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,056 |
2,626 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
780 |
569 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
932 |
915 |
$44K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,698 |
1,305 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
561 |
518 |
$29K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
214 |
195 |
$26K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,463 |
1,856 |
$23K |
| S0280 |
Medical home program, comprehensive care coordination and planning, initial plan |
736 |
533 |
$22K |
| D0240 |
|
934 |
605 |
$21K |
| 99502 |
|
351 |
324 |
$19K |
| 87210 |
|
4,258 |
3,639 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
965 |
938 |
$17K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
122 |
97 |
$14K |
| 99501 |
|
227 |
209 |
$12K |
| 90651 |
|
288 |
271 |
$7K |
| T1002 |
Rn services, up to 15 minutes |
171 |
153 |
$7K |
| 81025 |
|
1,037 |
857 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
43 |
38 |
$6K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
462 |
360 |
$6K |
| 90480 |
|
114 |
94 |
$5K |
| 90686 |
|
608 |
486 |
$5K |
| 36415 |
Collection of venous blood by venipuncture |
1,769 |
1,581 |
$4K |
| 90715 |
|
471 |
410 |
$4K |
| 91320 |
|
80 |
72 |
$4K |
| D1354 |
|
416 |
162 |
$4K |
| 90713 |
|
118 |
114 |
$2K |
| 81002 |
|
501 |
439 |
$2K |
| 86480 |
|
29 |
26 |
$1K |
| 90632 |
|
16 |
14 |
$1K |
| 85018 |
|
394 |
351 |
$983.20 |
| S9442 |
Birthing classes, non-physician provider, per session |
111 |
83 |
$945.10 |
| 90656 |
|
133 |
128 |
$643.03 |
| 86787 |
|
23 |
21 |
$241.08 |
| 90620 |
|
111 |
103 |
$191.03 |
| 99406 |
|
27 |
18 |
$155.13 |
| 90696 |
|
32 |
31 |
$55.84 |
| 90734 |
|
411 |
387 |
$0.07 |
| 90710 |
|
48 |
44 |
$0.00 |
| 90633 |
|
77 |
74 |
$0.00 |