| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
16,008 |
15,835 |
$650K |
| D0330 |
Panoramic radiographic image |
5,605 |
5,548 |
$569K |
| D1110 |
Prophylaxis - adult |
8,202 |
8,119 |
$494K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,252 |
2,075 |
$318K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,846 |
3,082 |
$303K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,783 |
2,878 |
$176K |
| D0191 |
|
9,924 |
9,842 |
$145K |
| D1351 |
Sealant - per tooth |
12,514 |
3,368 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,532 |
4,487 |
$109K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
734 |
671 |
$104K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
648 |
604 |
$91K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,570 |
20,353 |
$68K |
| D1120 |
Prophylaxis - child |
12,035 |
11,920 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
355 |
353 |
$55K |
| D1330 |
|
29,850 |
29,518 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,574 |
1,567 |
$22K |
| D0274 |
Bitewings - four radiographic images |
8,186 |
8,100 |
$20K |
| D0272 |
Bitewings - two radiographic images |
8,475 |
8,391 |
$18K |
| D9999 |
Unspecified adjunctive procedure, by report |
299 |
299 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
130 |
118 |
$10K |
| D4346 |
|
110 |
95 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
542 |
540 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
636 |
592 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
127 |
127 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,346 |
1,224 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
88 |
$4K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
136 |
129 |
$4K |
| D0601 |
|
5,048 |
4,941 |
$3K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
13 |
13 |
$2K |
| D0602 |
|
2,714 |
2,673 |
$2K |
| D0603 |
|
2,218 |
2,185 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
468 |
464 |
$2K |
| D3120 |
|
1,066 |
881 |
$754.88 |
| D1999 |
|
12 |
12 |
$480.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
28 |
28 |
$380.00 |
| 90715 |
|
176 |
160 |
$291.50 |
| 99442 |
|
15 |
13 |
$211.80 |
| 90651 |
|
57 |
53 |
$71.50 |
| 90734 |
|
48 |
45 |
$11.00 |
| 90744 |
|
122 |
115 |
$5.00 |
| D9986 |
|
4,857 |
4,734 |
$0.00 |
| 90713 |
|
310 |
294 |
$0.00 |
| D9987 |
|
278 |
265 |
$0.00 |
| 90633 |
|
62 |
61 |
$0.00 |
| 90707 |
|
211 |
199 |
$0.00 |
| D1354 |
|
51 |
16 |
$0.00 |
| 90716 |
|
292 |
282 |
$0.00 |