| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
21,739 |
18,866 |
$759K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15,644 |
12,486 |
$757K |
| D1351 |
Sealant - per tooth |
17,783 |
4,672 |
$538K |
| D0602 |
|
25,767 |
23,270 |
$465K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,964 |
10,587 |
$266K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
8,262 |
6,404 |
$248K |
| D0272 |
Bitewings - two radiographic images |
9,294 |
8,094 |
$233K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,401 |
3,835 |
$226K |
| D0601 |
|
11,917 |
11,085 |
$221K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,393 |
1,477 |
$212K |
| D1206 |
Topical application of fluoride varnish |
10,093 |
8,508 |
$203K |
| 90834 |
Psychotherapy, 45 minutes with patient |
3,548 |
1,592 |
$198K |
| V5008 |
Hearing screening |
17,815 |
17,054 |
$195K |
| 99173 |
|
19,377 |
17,252 |
$173K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
9,716 |
7,881 |
$160K |
| D0274 |
Bitewings - four radiographic images |
3,756 |
3,287 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
3,444 |
2,834 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
4,159 |
3,372 |
$107K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,841 |
1,469 |
$101K |
| D0603 |
|
4,923 |
4,292 |
$83K |
| D9110 |
|
761 |
720 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
697 |
494 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
527 |
412 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,671 |
2,333 |
$42K |
| 90837 |
Psychotherapy, 53 minutes with patient |
368 |
222 |
$31K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
321 |
301 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,157 |
778 |
$16K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
172 |
168 |
$11K |
| 90791 |
Psychiatric diagnostic evaluation |
105 |
90 |
$9K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
653 |
539 |
$6K |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
229 |
117 |
$6K |
| 90847 |
Family psychotherapy with the patient present, 50 minutes |
65 |
35 |
$5K |
| 96150 |
|
258 |
250 |
$5K |
| 99384 |
|
44 |
44 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
13 |
$2K |
| 96156 |
|
65 |
65 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$967.80 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
88 |
79 |
$475.94 |
| 99411 |
|
39 |
39 |
$407.94 |
| 90686 |
|
159 |
128 |
$1.00 |
| 90715 |
|
18 |
12 |
$0.00 |
| 90633 |
|
13 |
13 |
$0.00 |
| 90672 |
|
21 |
12 |
$0.00 |
| 96127 |
|
13 |
13 |
$0.00 |