| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
51,613 |
51,279 |
$256K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,081 |
2,182 |
$240K |
| D0120 |
Periodic oral evaluation - established patient |
8,417 |
8,011 |
$233K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,288 |
1,651 |
$233K |
| D1110 |
Prophylaxis - adult |
5,006 |
4,725 |
$203K |
| D0330 |
Panoramic radiographic image |
3,011 |
2,841 |
$181K |
| D1120 |
Prophylaxis - child |
5,218 |
4,953 |
$154K |
| D1206 |
Topical application of fluoride varnish |
8,507 |
8,076 |
$145K |
| D0274 |
Bitewings - four radiographic images |
3,496 |
3,314 |
$120K |
| D1351 |
Sealant - per tooth |
3,081 |
1,090 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
2,306 |
2,177 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,968 |
1,834 |
$89K |
| D0272 |
Bitewings - two radiographic images |
2,535 |
2,408 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
1,887 |
1,758 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
340 |
256 |
$23K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,569 |
1,181 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
111 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
175 |
156 |
$12K |
| D4355 |
|
144 |
141 |
$9K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
423 |
333 |
$9K |
| D2330 |
|
56 |
40 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
59 |
55 |
$3K |
| D2331 |
|
34 |
26 |
$3K |
| D2332 |
|
18 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
63 |
$1K |
| 81025 |
|
164 |
143 |
$933.16 |
| 90734 |
|
237 |
177 |
$642.89 |
| 90686 |
|
339 |
240 |
$465.63 |
| 90651 |
|
31 |
24 |
$210.24 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
17 |
15 |
$131.25 |
| 36415 |
Collection of venous blood by venipuncture |
36 |
28 |
$84.50 |
| 90715 |
|
56 |
45 |
$38.93 |
| 99173 |
|
156 |
131 |
$2.00 |
| 90633 |
|
23 |
17 |
$0.00 |
| 92551 |
|
63 |
52 |
$0.00 |