| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99199 |
Unlisted special service, procedure or report |
448,933 |
444,026 |
$2.27M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,438 |
809 |
$249K |
| D1351 |
Sealant - per tooth |
5,078 |
983 |
$145K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,217 |
6,019 |
$97K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,574 |
2,260 |
$78K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
3,095 |
2,548 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
930 |
391 |
$72K |
| D1120 |
Prophylaxis - child |
2,615 |
2,440 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,457 |
1,087 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,374 |
1,302 |
$63K |
| D0330 |
Panoramic radiographic image |
840 |
789 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,768 |
2,586 |
$45K |
| D0272 |
Bitewings - two radiographic images |
2,044 |
1,905 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,258 |
1,150 |
$32K |
| 83655 |
|
2,193 |
1,976 |
$31K |
| 90716 |
|
362 |
324 |
$31K |
| 99502 |
|
511 |
318 |
$24K |
| 99501 |
|
539 |
364 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
462 |
$18K |
| 81025 |
|
1,996 |
1,777 |
$16K |
| 90686 |
|
2,733 |
2,351 |
$10K |
| 90715 |
|
1,239 |
1,025 |
$9K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
434 |
367 |
$7K |
| 97802 |
|
105 |
80 |
$6K |
| 90651 |
|
332 |
284 |
$6K |
| 90713 |
|
230 |
213 |
$6K |
| 90734 |
|
904 |
712 |
$5K |
| 87210 |
|
1,248 |
1,010 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
42 |
$4K |
| 86592 |
|
754 |
618 |
$3K |
| 96152 |
|
61 |
40 |
$3K |
| 91322 |
|
33 |
31 |
$3K |
| 90746 |
|
37 |
37 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
33 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$2K |
| 90619 |
|
505 |
405 |
$2K |
| 90620 |
|
48 |
40 |
$2K |
| 90480 |
|
57 |
53 |
$1K |
| 90656 |
|
179 |
161 |
$1K |
| 90632 |
|
16 |
15 |
$1K |
| S9442 |
Birthing classes, non-physician provider, per session |
60 |
28 |
$973.28 |
| 82120 |
|
105 |
81 |
$314.43 |
| 92587 |
|
12 |
12 |
$116.72 |
| 85018 |
|
16 |
16 |
$47.44 |
| 90633 |
|
106 |
89 |
$23.57 |
| 90710 |
|
79 |
61 |
$0.00 |
| 90670 |
|
38 |
30 |
$0.00 |
| 90723 |
|
16 |
12 |
$0.00 |
| 90647 |
|
15 |
12 |
$0.00 |
| 90744 |
|
23 |
20 |
$0.00 |
| 90696 |
|
24 |
17 |
$0.00 |
| 90674 |
|
16 |
13 |
$0.00 |