| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
3,454 |
3,105 |
$472K |
| D0120 |
Periodic oral evaluation - established patient |
7,524 |
7,420 |
$425K |
| D1110 |
Prophylaxis - adult |
3,282 |
3,253 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,840 |
1,457 |
$165K |
| D1120 |
Prophylaxis - child |
6,274 |
6,243 |
$155K |
| D0330 |
Panoramic radiographic image |
1,974 |
1,953 |
$152K |
| 99403 |
|
1,023 |
964 |
$140K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,495 |
1,116 |
$86K |
| D1351 |
Sealant - per tooth |
7,810 |
2,326 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,288 |
1,271 |
$71K |
| D1206 |
Topical application of fluoride varnish |
9,796 |
9,731 |
$48K |
| D0191 |
|
1,090 |
1,089 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
919 |
705 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
865 |
818 |
$32K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
244 |
231 |
$26K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,484 |
1,417 |
$25K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
171 |
158 |
$22K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,481 |
2,294 |
$21K |
| D9999 |
Unspecified adjunctive procedure, by report |
785 |
764 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
177 |
$20K |
| D1330 |
|
9,790 |
9,724 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
677 |
664 |
$13K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,170 |
2,989 |
$12K |
| D0272 |
Bitewings - two radiographic images |
3,735 |
3,699 |
$11K |
| D1999 |
|
159 |
159 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,952 |
1,907 |
$9K |
| D0274 |
Bitewings - four radiographic images |
2,564 |
2,520 |
$8K |
| D0190 |
|
586 |
586 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
123 |
115 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
937 |
521 |
$2K |
| D0603 |
|
2,615 |
2,568 |
$2K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
12 |
12 |
$2K |
| 90715 |
|
756 |
724 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$2K |
| D0240 |
|
292 |
227 |
$936.91 |
| D0602 |
|
1,119 |
1,092 |
$903.96 |
| 90686 |
|
642 |
602 |
$866.64 |
| D0601 |
|
1,275 |
1,262 |
$812.00 |
| 90633 |
|
704 |
684 |
$720.79 |
| D0999 |
Unspecified diagnostic procedure, by report |
25 |
25 |
$500.00 |
| 90651 |
|
549 |
528 |
$368.00 |
| D2940 |
|
14 |
13 |
$306.74 |
| 90696 |
|
92 |
84 |
$236.48 |
| 90734 |
|
224 |
213 |
$159.50 |
| 90710 |
|
134 |
126 |
$71.50 |
| 90647 |
|
27 |
25 |
$60.50 |
| 90671 |
|
26 |
26 |
$0.01 |
| D9986 |
|
2,299 |
2,208 |
$0.00 |
| 90713 |
|
348 |
341 |
$0.00 |
| 90707 |
|
39 |
39 |
$0.00 |
| 90670 |
|
82 |
78 |
$0.00 |
| 90619 |
|
98 |
96 |
$0.00 |
| 90723 |
|
25 |
25 |
$0.00 |
| 90716 |
|
392 |
382 |
$0.00 |
| 90744 |
|
50 |
50 |
$0.00 |