| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
8,387 |
6,361 |
$812K |
| T1015 |
Clinic visit/encounter, all-inclusive |
5,702 |
3,244 |
$601K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,833 |
1,684 |
$222.57 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
874 |
629 |
$209.94 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
934 |
881 |
$136.36 |
| D0120 |
Periodic oral evaluation - established patient |
2,266 |
2,128 |
$112.00 |
| D0274 |
Bitewings - four radiographic images |
574 |
552 |
$107.48 |
| 90686 |
|
440 |
283 |
$85.06 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
826 |
541 |
$61.70 |
| D1120 |
Prophylaxis - child |
2,216 |
2,109 |
$41.00 |
| D1206 |
Topical application of fluoride varnish |
2,477 |
2,358 |
$26.00 |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
95 |
$6.61 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
762 |
550 |
$0.00 |
| D0603 |
|
95 |
89 |
$0.00 |
| D1330 |
|
218 |
203 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
187 |
175 |
$0.00 |
| D1351 |
Sealant - per tooth |
95 |
65 |
$0.00 |
| 92551 |
|
117 |
69 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
26 |
26 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
217 |
160 |
$0.00 |
| 99173 |
|
136 |
86 |
$0.00 |
| D1110 |
Prophylaxis - adult |
75 |
59 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
762 |
568 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
29 |
29 |
$0.00 |
| 81025 |
|
16 |
12 |
$0.00 |
| 81002 |
|
46 |
27 |
$0.00 |