| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
11,237 |
10,875 |
$577K |
| D1110 |
Prophylaxis - adult |
4,489 |
4,336 |
$371K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,003 |
1,342 |
$145K |
| D1351 |
Sealant - per tooth |
6,671 |
1,638 |
$108K |
| D0240 |
|
3,746 |
2,508 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,310 |
1,287 |
$94K |
| D1206 |
Topical application of fluoride varnish |
14,046 |
13,604 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,018 |
711 |
$54K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,767 |
8,149 |
$29K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
4,639 |
4,240 |
$25K |
| D1120 |
Prophylaxis - child |
8,015 |
7,779 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
4,332 |
4,163 |
$20K |
| D9999 |
Unspecified adjunctive procedure, by report |
280 |
276 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
247 |
174 |
$12K |
| D0274 |
Bitewings - four radiographic images |
6,000 |
5,790 |
$12K |
| D1330 |
|
12,638 |
12,251 |
$9K |
| D0272 |
Bitewings - two radiographic images |
4,231 |
4,102 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
43 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
352 |
344 |
$5K |
| 90686 |
|
2,492 |
2,264 |
$4K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
32 |
29 |
$4K |
| D9920 |
|
131 |
120 |
$4K |
| 90715 |
|
952 |
896 |
$3K |
| D0330 |
Panoramic radiographic image |
53 |
53 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,576 |
3,366 |
$3K |
| 90696 |
|
494 |
435 |
$1K |
| 90651 |
|
985 |
935 |
$911.90 |
| 90670 |
|
638 |
573 |
$594.00 |
| 90633 |
|
632 |
598 |
$572.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
41 |
39 |
$484.88 |
| 90698 |
|
36 |
36 |
$363.00 |
| 90734 |
|
396 |
379 |
$355.27 |
| 90707 |
|
207 |
201 |
$291.50 |
| D3120 |
|
46 |
32 |
$284.40 |
| D0999 |
Unspecified diagnostic procedure, by report |
13 |
13 |
$260.00 |
| 90710 |
|
710 |
639 |
$225.50 |
| 90716 |
|
913 |
863 |
$214.50 |
| 90700 |
|
285 |
269 |
$165.00 |
| 90723 |
|
16 |
16 |
$143.00 |
| 90647 |
|
138 |
117 |
$137.50 |
| D0601 |
|
943 |
937 |
$133.00 |
| 90744 |
|
419 |
411 |
$89.50 |
| 90620 |
|
27 |
24 |
$71.50 |
| D0602 |
|
657 |
651 |
$67.00 |
| 90713 |
|
483 |
465 |
$66.00 |
| D0603 |
|
872 |
822 |
$55.00 |
| 90714 |
|
37 |
37 |
$16.50 |
| 90672 |
|
124 |
123 |
$0.00 |
| 90671 |
|
177 |
174 |
$0.00 |
| 90656 |
|
94 |
94 |
$0.00 |
| 90674 |
|
16 |
16 |
$0.00 |
| 90619 |
|
79 |
75 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
106 |
$0.00 |
| 90660 |
|
27 |
27 |
$0.00 |