| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,090 |
8,561 |
$569K |
| D1206 |
Topical application of fluoride varnish |
11,377 |
9,609 |
$412K |
| D0120 |
Periodic oral evaluation - established patient |
10,243 |
8,646 |
$402K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
19,432 |
17,054 |
$231K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
6,676 |
5,955 |
$106K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,166 |
835 |
$86K |
| D1351 |
Sealant - per tooth |
792 |
420 |
$74K |
| 90651 |
|
2,631 |
2,320 |
$72K |
| H1000 |
Prenatal care, at-risk assessment |
4,693 |
4,082 |
$64K |
| 96127 |
|
3,746 |
2,957 |
$52K |
| 90670 |
|
4,586 |
4,290 |
$51K |
| 90686 |
|
4,993 |
4,389 |
$49K |
| 90716 |
|
3,248 |
2,936 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,511 |
1,260 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,561 |
1,386 |
$41K |
| 90723 |
|
4,099 |
3,730 |
$41K |
| 90647 |
|
4,094 |
3,740 |
$40K |
| 90707 |
|
3,162 |
2,858 |
$40K |
| D0272 |
Bitewings - two radiographic images |
3,166 |
2,624 |
$40K |
| 90715 |
|
2,079 |
1,783 |
$32K |
| 90633 |
|
2,942 |
2,692 |
$30K |
| 90677 |
|
615 |
517 |
$25K |
| 90734 |
|
1,554 |
1,507 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,027 |
790 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
373 |
251 |
$21K |
| 90681 |
|
2,066 |
1,895 |
$20K |
| 90619 |
|
1,223 |
936 |
$20K |
| 90700 |
|
1,461 |
1,344 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,592 |
1,298 |
$13K |
| 90696 |
|
1,050 |
934 |
$12K |
| 85018 |
|
5,025 |
4,305 |
$11K |
| 91320 |
|
133 |
73 |
$10K |
| 90620 |
|
551 |
444 |
$10K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
175 |
97 |
$8K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
174 |
96 |
$8K |
| 90621 |
|
369 |
346 |
$8K |
| 36416 |
|
1,568 |
1,354 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
91 |
$5K |
| 90656 |
|
237 |
184 |
$4K |
| 81025 |
|
919 |
746 |
$3K |
| 86780 |
|
187 |
118 |
$3K |
| 86701 |
|
173 |
106 |
$2K |
| 86702 |
|
193 |
116 |
$2K |
| 96160 |
|
168 |
128 |
$2K |
| 91319 |
|
52 |
40 |
$1K |
| 90713 |
|
120 |
107 |
$1K |
| 90685 |
|
166 |
163 |
$1K |
| 90674 |
|
24 |
19 |
$658.35 |
| 90756 |
|
34 |
18 |
$548.21 |
| 99201 |
|
18 |
13 |
$494.60 |
| 90710 |
|
19 |
17 |
$342.47 |
| 90744 |
|
29 |
26 |
$333.85 |
| 90381 |
|
18 |
15 |
$300.78 |
| 90698 |
|
17 |
14 |
$284.07 |
| 90688 |
|
15 |
15 |
$274.00 |
| 86580 |
|
68 |
41 |
$268.00 |
| 90680 |
|
16 |
13 |
$267.36 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
21 |
18 |
$206.01 |
| 36415 |
Collection of venous blood by venipuncture |
66 |
38 |
$8.20 |