| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,393 |
3,282 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,346 |
3,241 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,615 |
2,533 |
$52K |
| D1110 |
Prophylaxis - adult |
898 |
879 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
545 |
532 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,130 |
1,107 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
579 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
141 |
$14K |
| D0272 |
Bitewings - two radiographic images |
806 |
769 |
$13K |
| D0274 |
Bitewings - four radiographic images |
501 |
491 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
107 |
$10K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
124 |
102 |
$7K |
| 90677 |
|
91 |
75 |
$7K |
| D1351 |
Sealant - per tooth |
220 |
64 |
$6K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
180 |
149 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
65 |
54 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
175 |
168 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
43 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
195 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
98 |
95 |
$2K |
| D0330 |
Panoramic radiographic image |
44 |
41 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
238 |
167 |
$1K |
| 96127 |
|
148 |
93 |
$242.26 |
| 90474 |
|
38 |
29 |
$232.00 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
14 |
13 |
$203.28 |
| 36415 |
Collection of venous blood by venipuncture |
203 |
124 |
$173.86 |
| 81025 |
|
66 |
42 |
$135.15 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
206 |
170 |
$120.40 |
| 81003 |
|
324 |
174 |
$103.72 |
| 96161 |
|
133 |
107 |
$80.40 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
35 |
26 |
$71.80 |
| 90461 |
|
124 |
101 |
$66.21 |
| 97803 |
|
15 |
14 |
$34.68 |
| 83655 |
|
15 |
12 |
$14.37 |
| 85018 |
|
16 |
13 |
$2.82 |
| 90710 |
|
15 |
13 |
$0.01 |
| 90633 |
|
18 |
15 |
$0.01 |
| 1160F |
|
1,117 |
736 |
$0.00 |
| 1159F |
|
1,089 |
736 |
$0.00 |
| 0502F |
|
363 |
191 |
$0.00 |
| 3078F |
|
470 |
277 |
$0.00 |
| 90681 |
|
38 |
29 |
$0.00 |
| D1330 |
|
5,363 |
5,202 |
$0.00 |
| D1310 |
|
384 |
378 |
$0.00 |
| 3008F |
|
754 |
438 |
$0.00 |
| 3074F |
|
536 |
307 |
$0.00 |
| 36416 |
|
15 |
12 |
$0.00 |
| 1036F |
|
22 |
21 |
$0.00 |
| 90697 |
|
38 |
28 |
$0.00 |
| 90686 |
|
71 |
62 |
$0.00 |
| 0503F |
|
26 |
14 |
$0.00 |