| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,091 |
2,065 |
$211K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
1,983 |
1,804 |
$179K |
| D0120 |
Periodic oral evaluation - established patient |
3,382 |
3,339 |
$143K |
| D1110 |
Prophylaxis - adult |
2,165 |
2,138 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,112 |
772 |
$80K |
| D1120 |
Prophylaxis - child |
3,340 |
3,288 |
$70K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
600 |
577 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,715 |
1,700 |
$56K |
| 99403 |
|
511 |
481 |
$53K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
592 |
537 |
$51K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
1,038 |
935 |
$46K |
| D1351 |
Sealant - per tooth |
7,429 |
2,004 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
194 |
140 |
$25K |
| D1206 |
Topical application of fluoride varnish |
6,303 |
6,209 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
216 |
204 |
$19K |
| D0190 |
|
971 |
948 |
$18K |
| T1002 |
Rn services, up to 15 minutes |
4,721 |
4,648 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
323 |
261 |
$13K |
| 99385 |
|
83 |
82 |
$10K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
1,450 |
1,326 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,113 |
1,967 |
$9K |
| D0274 |
Bitewings - four radiographic images |
2,075 |
2,046 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$7K |
| D1330 |
|
6,334 |
6,239 |
$7K |
| D0272 |
Bitewings - two radiographic images |
2,151 |
2,120 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
379 |
376 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
128 |
128 |
$3K |
| 90715 |
|
440 |
413 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
312 |
309 |
$1K |
| 90686 |
|
81 |
69 |
$420.50 |
| 90633 |
|
111 |
105 |
$349.51 |
| 90651 |
|
265 |
238 |
$223.00 |
| 90696 |
|
54 |
54 |
$163.00 |
| 90734 |
|
154 |
133 |
$65.50 |
| 90647 |
|
15 |
13 |
$55.02 |
| 90710 |
|
116 |
116 |
$15.49 |
| 90670 |
|
68 |
65 |
$0.03 |
| D9986 |
|
2,182 |
2,107 |
$0.00 |
| D9987 |
|
39 |
36 |
$0.00 |