| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
21,096 |
17,707 |
$2.32M |
| T1015 |
Clinic visit/encounter, all-inclusive |
5,924 |
4,210 |
$674K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
580 |
438 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
173 |
130 |
$2K |
| T1040 |
Medicaid certified community behavioral health clinic services, per diem |
19 |
19 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,643 |
5,169 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,869 |
2,479 |
$899.76 |
| D1351 |
Sealant - per tooth |
510 |
214 |
$792.00 |
| D4341 |
|
1,209 |
733 |
$732.00 |
| D1120 |
Prophylaxis - child |
3,305 |
3,003 |
$624.40 |
| D0210 |
Intraoral - complete series of radiographic images |
2,570 |
2,371 |
$554.82 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,202 |
1,717 |
$288.90 |
| D0274 |
Bitewings - four radiographic images |
2,206 |
2,008 |
$270.40 |
| D1206 |
Topical application of fluoride varnish |
2,806 |
2,540 |
$263.70 |
| D0120 |
Periodic oral evaluation - established patient |
1,974 |
1,825 |
$193.70 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
808 |
601 |
$147.52 |
| D0140 |
Limited oral evaluation - problem focused |
2,145 |
1,946 |
$129.60 |
| D1110 |
Prophylaxis - adult |
920 |
857 |
$127.80 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,407 |
1,728 |
$80.55 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,565 |
1,203 |
$61.70 |
| D0330 |
Panoramic radiographic image |
604 |
557 |
$45.20 |
| D0272 |
Bitewings - two radiographic images |
402 |
358 |
$28.20 |
| D0220 |
Intraoral - periapical first radiographic image |
3,554 |
3,280 |
$28.00 |
| 99173 |
|
137 |
119 |
$20.48 |
| 90686 |
|
98 |
64 |
$13.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,165 |
1,076 |
$3.80 |
| 36415 |
Collection of venous blood by venipuncture |
106 |
98 |
$0.00 |
| D0601 |
|
118 |
95 |
$0.00 |
| D1310 |
|
316 |
241 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
88 |
$0.00 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
42 |
38 |
$0.00 |
| 81000 |
|
27 |
25 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
20 |
13 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |
| D0603 |
|
31 |
29 |
$0.00 |
| 82962 |
|
17 |
13 |
$0.00 |
| D2330 |
|
16 |
14 |
$0.00 |
| 81025 |
|
340 |
246 |
$0.00 |
| D9110 |
|
1,066 |
981 |
$0.00 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
21 |
21 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
41 |
39 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
81 |
78 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
30 |
$0.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
105 |
90 |
$0.00 |
| D1354 |
|
26 |
17 |
$0.00 |
| 0502F |
|
92 |
51 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
15 |
15 |
$0.00 |