| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,074 |
1,951 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
2,294 |
2,179 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
915 |
753 |
$26K |
| D0190 |
|
3,201 |
3,061 |
$24K |
| D1120 |
Prophylaxis - child |
1,228 |
1,158 |
$24K |
| D1110 |
Prophylaxis - adult |
848 |
788 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
407 |
393 |
$16K |
| D1351 |
Sealant - per tooth |
1,707 |
722 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,558 |
1,466 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
437 |
386 |
$11K |
| D1206 |
Topical application of fluoride varnish |
4,926 |
4,681 |
$10K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
44 |
44 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
390 |
388 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,757 |
1,656 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
70 |
65 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
28 |
28 |
$2K |
| D1330 |
|
2,380 |
2,249 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
27 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
144 |
$1K |
| 90686 |
|
121 |
120 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,832 |
3,584 |
$438.18 |
| D0220 |
Intraoral - periapical first radiographic image |
4,223 |
3,962 |
$356.73 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
26 |
26 |
$260.00 |
| 3008F |
|
1,291 |
1,231 |
$0.01 |
| 99173 |
|
265 |
246 |
$0.00 |
| 3078F |
|
28 |
26 |
$0.00 |
| 90655 |
|
14 |
14 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
36 |
35 |
$0.00 |
| 3725F |
|
26 |
26 |
$0.00 |
| 1160F |
|
19 |
18 |
$0.00 |
| 1159F |
|
19 |
18 |
$0.00 |
| 4004F |
|
13 |
13 |
$0.00 |
| 92551 |
|
237 |
226 |
$0.00 |
| D1355 |
|
45 |
45 |
$0.00 |
| 1000F |
|
91 |
91 |
$0.00 |
| 3074F |
|
51 |
49 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
15 |
15 |
$0.00 |
| 1036F |
|
36 |
36 |
$0.00 |
| 0513F |
|
45 |
43 |
$0.00 |