| Code | Description | Claims | Beneficiaries | Total Paid |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
18,446 |
9,606 |
$1.52M |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,275 |
1,825 |
$254K |
| D1110 |
Prophylaxis - adult |
2,831 |
1,310 |
$104K |
| 99442 |
|
878 |
754 |
$101K |
| 99443 |
|
765 |
702 |
$97K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
806 |
477 |
$62K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
588 |
292 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
953 |
517 |
$35K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
215 |
170 |
$31K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
388 |
205 |
$31K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
435 |
220 |
$29K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
383 |
178 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,243 |
1,142 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
265 |
118 |
$17K |
| 99441 |
|
131 |
118 |
$17K |
| D0330 |
Panoramic radiographic image |
659 |
539 |
$15K |
| D0274 |
Bitewings - four radiographic images |
706 |
684 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
348 |
265 |
$10K |
| D1120 |
Prophylaxis - child |
274 |
131 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
59 |
25 |
$5K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
34 |
30 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
255 |
226 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
393 |
385 |
$4K |
| D4355 |
|
143 |
35 |
$3K |
| 94760 |
|
188 |
172 |
$713.32 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$593.33 |
| D1208 |
Topical application of fluoride, excluding varnish |
58 |
58 |
$547.29 |
| 92551 |
|
30 |
13 |
$354.51 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$300.19 |
| 92552 |
|
12 |
12 |
$154.36 |
| 97750 |
|
15 |
15 |
$35.96 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
17 |
17 |
$22.00 |
| 97802 |
|
64 |
58 |
$18.75 |
| 36415 |
Collection of venous blood by venipuncture |
13 |
13 |
$9.28 |
| D1330 |
|
239 |
239 |
$0.00 |
| D0602 |
|
131 |
131 |
$0.00 |
| D0603 |
|
16 |
16 |
$0.00 |
| 3008F |
|
136 |
124 |
$0.00 |
| 90658 |
|
14 |
13 |
$0.00 |