| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
22,002 |
21,814 |
$1.24M |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,907 |
4,738 |
$772K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,863 |
6,178 |
$654K |
| D0330 |
Panoramic radiographic image |
9,428 |
9,339 |
$609K |
| D0120 |
Periodic oral evaluation - established patient |
9,407 |
9,338 |
$400K |
| D1206 |
Topical application of fluoride varnish |
30,236 |
29,986 |
$393K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,731 |
5,626 |
$371K |
| D1351 |
Sealant - per tooth |
32,345 |
11,022 |
$279K |
| D1110 |
Prophylaxis - adult |
3,124 |
3,103 |
$231K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,850 |
6,819 |
$223K |
| D0191 |
|
20,476 |
20,298 |
$149K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
737 |
681 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
7,763 |
7,645 |
$81K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
499 |
482 |
$76K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
8,039 |
7,831 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
494 |
493 |
$49K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
6,002 |
5,668 |
$39K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,667 |
1,655 |
$38K |
| D1330 |
|
30,586 |
30,332 |
$35K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
166 |
160 |
$27K |
| 99403 |
|
123 |
116 |
$21K |
| D0272 |
Bitewings - two radiographic images |
6,205 |
6,170 |
$16K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
3,327 |
3,229 |
$16K |
| D1999 |
|
243 |
243 |
$15K |
| D3120 |
|
2,637 |
2,169 |
$14K |
| 99385 |
|
67 |
65 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
3,831 |
3,790 |
$9K |
| D0274 |
Bitewings - four radiographic images |
2,557 |
2,545 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
115 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45 |
43 |
$6K |
| D0999 |
Unspecified diagnostic procedure, by report |
261 |
261 |
$5K |
| D0603 |
|
1,587 |
1,586 |
$3K |
| D2330 |
|
34 |
25 |
$2K |
| D0601 |
|
1,652 |
1,650 |
$1K |
| D0602 |
|
1,301 |
1,299 |
$1K |
| D2332 |
|
20 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,270 |
1,168 |
$963.47 |
| 90473 |
|
210 |
205 |
$786.50 |
| 90632 |
|
72 |
66 |
$716.87 |
| D9310 |
|
14 |
14 |
$467.14 |
| D3110 |
|
58 |
58 |
$160.38 |
| 90633 |
|
898 |
873 |
$85.50 |
| 90696 |
|
485 |
478 |
$71.50 |
| 90647 |
|
218 |
205 |
$60.50 |
| 90686 |
|
522 |
491 |
$47.35 |
| 90715 |
|
1,429 |
1,404 |
$44.00 |
| 90670 |
|
633 |
606 |
$38.50 |
| 90651 |
|
896 |
885 |
$22.00 |
| 90707 |
|
69 |
66 |
$22.00 |
| 90710 |
|
721 |
707 |
$11.00 |
| 90723 |
|
147 |
142 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
180 |
157 |
$0.00 |
| 90716 |
|
139 |
135 |
$0.00 |
| 90697 |
|
98 |
93 |
$0.00 |
| 90744 |
|
12 |
12 |
$0.00 |
| 90700 |
|
111 |
102 |
$0.00 |
| 90681 |
|
58 |
54 |
$0.00 |
| 90734 |
|
700 |
689 |
$0.00 |
| 90671 |
|
155 |
153 |
$0.00 |
| 90713 |
|
24 |
24 |
$0.00 |