| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,315 |
3,876 |
$355K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,306 |
2,196 |
$146K |
| D1110 |
Prophylaxis - adult |
1,086 |
1,026 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,702 |
1,613 |
$77K |
| D1120 |
Prophylaxis - child |
3,415 |
3,224 |
$75K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,057 |
920 |
$68K |
| D1351 |
Sealant - per tooth |
4,240 |
1,054 |
$38K |
| 1159F |
|
907 |
858 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,509 |
1,492 |
$18K |
| D0191 |
|
418 |
377 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
697 |
661 |
$6K |
| D9999 |
Unspecified adjunctive procedure, by report |
217 |
217 |
$5K |
| D1330 |
|
4,804 |
4,523 |
$5K |
| 1160F |
|
1,077 |
1,012 |
$5K |
| D0272 |
Bitewings - two radiographic images |
1,455 |
1,365 |
$4K |
| D0274 |
Bitewings - four radiographic images |
674 |
654 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
42 |
41 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,673 |
3,420 |
$4K |
| 3078F |
|
390 |
360 |
$3K |
| 1126F |
|
640 |
586 |
$3K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
639 |
628 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
220 |
204 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
28 |
$2K |
| D9996 |
|
307 |
300 |
$2K |
| 3074F |
|
488 |
448 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
15 |
12 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
300 |
245 |
$1K |
| D1999 |
|
31 |
31 |
$1K |
| 1125F |
|
250 |
226 |
$1K |
| D1354 |
|
169 |
75 |
$909.68 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
188 |
178 |
$754.50 |
| 1111F |
|
19 |
15 |
$655.02 |
| 3079F |
|
71 |
70 |
$491.28 |
| 81025 |
|
13 |
12 |
$57.86 |
| 90686 |
|
14 |
14 |
$55.00 |
| 90715 |
|
14 |
13 |
$42.00 |
| 81050 |
|
15 |
15 |
$21.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$0.00 |