| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0190 |
|
7,202 |
6,923 |
$359K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,624 |
3,173 |
$311K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,787 |
2,532 |
$295K |
| D1120 |
Prophylaxis - child |
4,015 |
3,986 |
$223K |
| D1110 |
Prophylaxis - adult |
2,403 |
2,390 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,028 |
2,987 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,905 |
4,886 |
$124K |
| D0274 |
Bitewings - four radiographic images |
2,519 |
2,498 |
$75K |
| D1351 |
Sealant - per tooth |
2,718 |
1,295 |
$72K |
| D1206 |
Topical application of fluoride varnish |
11,507 |
11,214 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
418 |
320 |
$49K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,411 |
1,121 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
598 |
589 |
$23K |
| D0272 |
Bitewings - two radiographic images |
3,682 |
3,661 |
$10K |
| D2330 |
|
165 |
145 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,200 |
1,144 |
$7K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
107 |
83 |
$6K |
| D1330 |
|
6,561 |
6,518 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
29 |
$4K |
| D2331 |
|
58 |
51 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
133 |
128 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
178 |
178 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
50 |
43 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
51 |
49 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,145 |
3,098 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
211 |
210 |
$2K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
36 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,466 |
2,433 |
$2K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
25 |
14 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
41 |
41 |
$820.00 |
| D1355 |
|
88 |
88 |
$340.21 |
| 90686 |
|
256 |
255 |
$243.91 |
| 1000F |
|
150 |
121 |
$0.00 |
| 3008F |
|
1,916 |
1,679 |
$0.00 |
| 92551 |
|
344 |
283 |
$0.00 |
| 1111F |
|
12 |
12 |
$0.00 |
| 3074F |
|
42 |
42 |
$0.00 |
| 1036F |
|
54 |
39 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
29 |
29 |
$0.00 |
| 0513F |
|
24 |
24 |
$0.00 |
| 1125F |
|
13 |
13 |
$0.00 |
| 99173 |
|
450 |
380 |
$0.00 |
| 3725F |
|
25 |
15 |
$0.00 |
| 1159F |
|
30 |
30 |
$0.00 |
| 1160F |
|
30 |
30 |
$0.00 |
| 4004F |
|
13 |
13 |
$0.00 |
| 3078F |
|
36 |
27 |
$0.00 |