| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
24,698 |
24,530 |
$810K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22,684 |
17,373 |
$670K |
| D0240 |
|
10,408 |
8,736 |
$388K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,776 |
1,844 |
$295K |
| D0330 |
Panoramic radiographic image |
3,409 |
3,391 |
$279K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,389 |
1,837 |
$245K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,151 |
2,551 |
$160K |
| D1351 |
Sealant - per tooth |
11,065 |
3,225 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
5,606 |
5,516 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,536 |
1,528 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,100 |
927 |
$64K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,191 |
1,020 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,476 |
7,456 |
$62K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
1,456 |
1,189 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
20,747 |
20,584 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,054 |
2,046 |
$46K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
997 |
703 |
$46K |
| D1206 |
Topical application of fluoride varnish |
25,481 |
25,297 |
$42K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
391 |
367 |
$31K |
| D1354 |
|
5,232 |
1,735 |
$28K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
601 |
370 |
$25K |
| 90832 |
Psychotherapy, 30 minutes with patient |
586 |
480 |
$23K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
2,258 |
1,663 |
$20K |
| D0272 |
Bitewings - two radiographic images |
17,997 |
17,889 |
$16K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
260 |
202 |
$12K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
155 |
146 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,473 |
935 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
678 |
677 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
4,543 |
4,447 |
$5K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
3,935 |
2,998 |
$4K |
| D1330 |
|
26,160 |
25,969 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
2,065 |
1,497 |
$3K |
| 99215 |
Prolong outpt/office vis |
64 |
63 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
103 |
103 |
$2K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$2K |
| D9996 |
|
440 |
439 |
$2K |
| 0002A |
|
80 |
80 |
$1K |
| D1999 |
|
22 |
22 |
$1K |
| 0001A |
|
92 |
92 |
$1K |
| D0350 |
|
422 |
421 |
$1K |
| 0071A |
|
53 |
52 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
42 |
42 |
$840.00 |
| 0072A |
|
36 |
36 |
$776.00 |
| 87430 |
|
207 |
138 |
$652.13 |
| D3120 |
|
69 |
40 |
$651.88 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
942 |
594 |
$558.60 |
| 90686 |
|
843 |
761 |
$545.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
23 |
19 |
$524.60 |
| D0191 |
|
531 |
530 |
$504.97 |
| 90834 |
Psychotherapy, 45 minutes with patient |
12 |
12 |
$424.58 |
| 99441 |
|
22 |
15 |
$208.86 |
| 90651 |
|
122 |
109 |
$170.00 |
| D9920 |
|
12 |
12 |
$107.49 |
| 85018 |
|
860 |
529 |
$77.49 |
| 90670 |
|
132 |
121 |
$55.00 |
| 90685 |
|
43 |
37 |
$45.00 |
| 90633 |
|
197 |
130 |
$20.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
221 |
79 |
$19.86 |
| 90698 |
|
17 |
15 |
$15.00 |
| 81003 |
|
28 |
20 |
$10.52 |
| D1310 |
|
8,482 |
8,417 |
$0.00 |
| 1126F |
|
227 |
227 |
$0.00 |
| 1036F |
|
72 |
65 |
$0.00 |
| 91307 |
|
61 |
54 |
$0.00 |
| 3074F |
|
144 |
126 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
31 |
31 |
$0.00 |
| 1000F |
|
120 |
106 |
$0.00 |
| 90647 |
|
55 |
49 |
$0.00 |
| 91301 |
|
27 |
27 |
$0.00 |
| 90680 |
|
16 |
14 |
$0.00 |
| 1160F |
|
659 |
627 |
$0.00 |
| 1159F |
|
660 |
628 |
$0.00 |
| 91300 |
|
168 |
136 |
$0.00 |
| 99173 |
|
12 |
12 |
$0.00 |
| 3078F |
|
72 |
61 |
$0.00 |
| 90734 |
|
27 |
26 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
19 |
19 |
$0.00 |