| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
24,035 |
16,375 |
$3.19M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
8,516 |
7,493 |
$1.16M |
| D0120 |
Periodic oral evaluation - established patient |
5,234 |
4,527 |
$277K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,430 |
2,154 |
$233K |
| D0330 |
Panoramic radiographic image |
4,155 |
3,903 |
$189K |
| D1110 |
Prophylaxis - adult |
2,518 |
2,387 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,360 |
3,143 |
$104K |
| D1351 |
Sealant - per tooth |
3,877 |
1,025 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,321 |
1,116 |
$54K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
545 |
464 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
947 |
812 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
3,279 |
3,062 |
$44K |
| 99403 |
|
243 |
227 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
743 |
560 |
$26K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,653 |
3,238 |
$24K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
140 |
127 |
$20K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
864 |
794 |
$19K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
5,605 |
4,844 |
$17K |
| 59025 |
Fetal non-stress test |
828 |
444 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
6,582 |
6,117 |
$13K |
| D1206 |
Topical application of fluoride varnish |
5,582 |
5,299 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
85 |
81 |
$11K |
| D1120 |
Prophylaxis - child |
1,587 |
1,502 |
$8K |
| D0190 |
|
1,011 |
985 |
$8K |
| 59430 |
|
113 |
58 |
$6K |
| 99381 |
|
44 |
34 |
$5K |
| D0272 |
Bitewings - two radiographic images |
4,514 |
4,280 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
46 |
33 |
$5K |
| 90715 |
|
843 |
804 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,958 |
2,761 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,361 |
3,684 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
73 |
73 |
$2K |
| D1330 |
|
5,539 |
5,260 |
$2K |
| 90723 |
|
252 |
230 |
$2K |
| 90696 |
|
397 |
358 |
$1K |
| 90670 |
|
532 |
497 |
$1K |
| 90633 |
|
837 |
800 |
$1K |
| 90647 |
|
295 |
267 |
$1K |
| 99201 |
|
14 |
14 |
$1K |
| 90686 |
|
434 |
423 |
$955.00 |
| 90710 |
|
737 |
695 |
$833.00 |
| 90700 |
|
98 |
91 |
$687.50 |
| 90651 |
|
752 |
717 |
$420.00 |
| 90734 |
|
610 |
578 |
$263.00 |
| D0270 |
|
454 |
427 |
$148.10 |
| 90681 |
|
49 |
41 |
$144.00 |
| 90698 |
|
15 |
14 |
$132.50 |
| 90620 |
|
125 |
118 |
$60.50 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$50.00 |
| 90713 |
|
32 |
31 |
$0.00 |
| 90671 |
|
24 |
24 |
$0.00 |
| 90707 |
|
30 |
13 |
$0.00 |
| 90716 |
|
13 |
13 |
$0.00 |