| Code | Description | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
$3.11M |
| S5165 |
Home modifications; per service |
$1.30M |
| 99403 |
|
$422K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
$213K |
| D1110 |
Prophylaxis - adult |
$161K |
| D1351 |
Sealant - per tooth |
$123K |
| D0330 |
Panoramic radiographic image |
$109K |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
$86K |