| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
9,087 |
8,638 |
$1.09M |
| D0120 |
Periodic oral evaluation - established patient |
2,884 |
2,766 |
$353K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
962 |
$143K |
| D1351 |
Sealant - per tooth |
2,861 |
495 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
559 |
$75K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
2,538 |
2,515 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,525 |
1,442 |
$62K |
| D0274 |
Bitewings - four radiographic images |
841 |
814 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
809 |
354 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
964 |
778 |
$23K |
| 80053 |
Comprehensive metabolic panel |
3,626 |
3,471 |
$21K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
515 |
510 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
197 |
107 |
$16K |
| D1110 |
Prophylaxis - adult |
634 |
610 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
143 |
100 |
$13K |
| D1120 |
Prophylaxis - child |
1,924 |
1,830 |
$11K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
3,421 |
3,253 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
66 |
64 |
$8K |
| 99232 |
Subsequent hospital care, per day, moderate complexity |
292 |
118 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,203 |
1,140 |
$5K |
| 87426 |
Infectious agent antigen detection, SARS-CoV-2 (COVID-19) |
142 |
140 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
197 |
195 |
$4K |
| 99238 |
Hospital discharge day management, 30 minutes or less |
86 |
81 |
$3K |
| D0330 |
Panoramic radiographic image |
694 |
670 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
433 |
420 |
$2K |
| 99173 |
|
383 |
383 |
$2K |
| 80061 |
Lipid panel |
267 |
260 |
$2K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
13 |
13 |
$1K |
| 99231 |
Subsequent hospital care, per day, straightforward or low complexity |
102 |
40 |
$1K |
| 84443 |
Thyroid stimulating hormone (TSH) |
112 |
110 |
$775.68 |
| 81001 |
|
191 |
180 |
$413.42 |
| 90686 |
|
146 |
146 |
$304.74 |
| 36415 |
Collection of venous blood by venipuncture |
4,653 |
4,274 |
$140.31 |
| 3008F |
|
12 |
12 |
$0.00 |