| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
599 |
398 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
361 |
328 |
$30K |
| H1000 |
Prenatal care, at-risk assessment |
299 |
169 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
227 |
164 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
113 |
111 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
56 |
$5K |
| D0272 |
Bitewings - two radiographic images |
232 |
232 |
$4K |
| D0274 |
Bitewings - four radiographic images |
94 |
94 |
$3K |
| D1120 |
Prophylaxis - child |
317 |
317 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
29 |
$3K |
| D7111 |
|
71 |
45 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
14 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
16 |
13 |
$1K |
| D1110 |
Prophylaxis - adult |
115 |
115 |
$1K |
| D1999 |
|
18 |
18 |
$760.00 |
| 81025 |
|
37 |
36 |
$755.90 |
| D1330 |
|
459 |
459 |
$481.70 |
| D0140 |
Limited oral evaluation - problem focused |
76 |
74 |
$438.29 |
| D1206 |
Topical application of fluoride varnish |
66 |
66 |
$378.41 |
| D1208 |
Topical application of fluoride, excluding varnish |
371 |
371 |
$152.36 |
| D0330 |
Panoramic radiographic image |
75 |
75 |
$117.01 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
28 |
26 |
$110.00 |