| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
28,739 |
22,084 |
$3.11M |
| 99403 |
|
4,043 |
3,739 |
$422K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,487 |
3,065 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
5,357 |
5,299 |
$213K |
| D1110 |
Prophylaxis - adult |
2,413 |
2,381 |
$161K |
| D1351 |
Sealant - per tooth |
6,162 |
1,821 |
$123K |
| D0330 |
Panoramic radiographic image |
1,070 |
1,070 |
$109K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
2,657 |
2,423 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,161 |
811 |
$86K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
571 |
528 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
1,036 |
$57K |
| 59430 |
|
716 |
653 |
$54K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
480 |
439 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,889 |
2,871 |
$39K |
| H1001 |
Prenatal care, at-risk enhanced service; antepartum management |
349 |
336 |
$33K |
| D0191 |
|
1,640 |
1,629 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
419 |
323 |
$19K |
| D1120 |
Prophylaxis - child |
3,616 |
3,576 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,777 |
5,708 |
$15K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,271 |
2,997 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
679 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
190 |
189 |
$11K |
| D1330 |
|
9,024 |
8,928 |
$11K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,836 |
1,682 |
$10K |
| 99401 |
|
456 |
440 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$8K |
| D0272 |
Bitewings - two radiographic images |
2,467 |
2,434 |
$8K |
| D0190 |
|
435 |
435 |
$7K |
| D0274 |
Bitewings - four radiographic images |
2,360 |
2,330 |
$6K |
| D0350 |
|
1,012 |
1,008 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
191 |
191 |
$4K |
| 99385 |
|
41 |
38 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
523 |
512 |
$4K |
| D9996 |
|
935 |
931 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
30 |
$2K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
92 |
85 |
$1K |
| 90715 |
|
615 |
573 |
$905.31 |
| 99219 |
|
19 |
12 |
$902.20 |
| 59025 |
Fetal non-stress test |
56 |
29 |
$895.52 |
| D1999 |
|
16 |
16 |
$640.00 |
| 90686 |
|
152 |
149 |
$419.90 |
| 90651 |
|
328 |
291 |
$324.50 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$260.00 |
| 90696 |
|
140 |
128 |
$214.50 |
| 90670 |
|
98 |
92 |
$105.60 |
| 90633 |
|
72 |
68 |
$78.10 |
| 90710 |
|
181 |
166 |
$77.00 |
| 90734 |
|
155 |
141 |
$15.40 |
| 90723 |
|
14 |
12 |
$11.00 |
| 90707 |
|
35 |
33 |
$11.00 |
| 90716 |
|
36 |
34 |
$8.80 |