| Code | Description | Claims | Beneficiaries | Total Paid |
| H1000 |
Prenatal care, at-risk assessment |
3,503 |
2,739 |
$548K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,012 |
3,117 |
$534K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
4,672 |
3,304 |
$519K |
| D1351 |
Sealant - per tooth |
22,014 |
7,357 |
$480K |
| 99403 |
|
3,310 |
3,162 |
$476K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,219 |
5,601 |
$467K |
| D0120 |
Periodic oral evaluation - established patient |
12,834 |
12,446 |
$467K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,189 |
3,162 |
$403K |
| D1206 |
Topical application of fluoride varnish |
31,191 |
30,415 |
$321K |
| D1110 |
Prophylaxis - adult |
5,430 |
5,284 |
$296K |
| D0330 |
Panoramic radiographic image |
4,006 |
3,868 |
$281K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,172 |
936 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,472 |
2,409 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,992 |
2,025 |
$95K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
700 |
515 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,497 |
2,423 |
$88K |
| D0191 |
|
13,611 |
13,358 |
$62K |
| D1120 |
Prophylaxis - child |
9,572 |
9,299 |
$49K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
444 |
313 |
$45K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
249 |
242 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
3,625 |
3,460 |
$37K |
| 99384 |
|
246 |
241 |
$36K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
840 |
673 |
$36K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
184 |
182 |
$31K |
| D1330 |
|
31,769 |
30,954 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
5,098 |
4,825 |
$27K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
162 |
148 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,292 |
1,198 |
$21K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
4,180 |
3,618 |
$17K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,508 |
2,168 |
$17K |
| D9999 |
Unspecified adjunctive procedure, by report |
458 |
456 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
72 |
64 |
$11K |
| 99383 |
|
59 |
59 |
$9K |
| D0272 |
Bitewings - two radiographic images |
5,464 |
5,271 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
123 |
85 |
$7K |
| D0274 |
Bitewings - four radiographic images |
4,128 |
3,986 |
$6K |
| D0190 |
|
1,830 |
1,777 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
40 |
$2K |
| 90715 |
|
785 |
731 |
$930.40 |
| D1310 |
|
1,685 |
1,625 |
$674.05 |
| 90686 |
|
412 |
331 |
$527.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
380 |
260 |
$481.01 |
| 90651 |
|
612 |
548 |
$458.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$447.77 |
| 90696 |
|
214 |
184 |
$413.50 |
| 90633 |
|
360 |
303 |
$243.50 |
| 90700 |
|
65 |
53 |
$144.00 |
| 90670 |
|
205 |
173 |
$122.50 |
| 90734 |
|
324 |
291 |
$96.00 |
| D1320 |
|
369 |
359 |
$84.76 |
| 90710 |
|
268 |
233 |
$82.50 |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
33 |
$57.60 |
| 90716 |
|
67 |
60 |
$44.00 |
| 90648 |
|
56 |
46 |
$20.00 |
| D9920 |
|
29 |
27 |
$0.00 |
| 90619 |
|
40 |
40 |
$0.00 |
| 90744 |
|
19 |
13 |
$0.00 |
| 90723 |
|
21 |
15 |
$0.00 |
| 90707 |
|
53 |
45 |
$0.00 |
| 90713 |
|
38 |
37 |
$0.00 |