| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H2036 |
Alcohol and/or other drug treatment program, per diem |
22,120 |
1,394 |
$5.82M |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
1,495 |
1,396 |
$3.65M |
| H0040 |
Assertive community treatment program, per diem |
26,314 |
4,072 |
$1.48M |
| H2015 |
Comprehensive community support services, per 15 minutes |
7,556 |
1,700 |
$723K |
| H2010 |
Comprehensive medication services, per 15 minutes |
3,719 |
2,478 |
$520K |
| D0120 |
Periodic oral evaluation - established patient |
16,964 |
16,783 |
$512K |
| D1110 |
Prophylaxis - adult |
9,618 |
9,480 |
$493K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
8,515 |
3,239 |
$435K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,109 |
3,184 |
$415K |
| H2034 |
Alcohol and/or drug abuse halfway house services, per diem |
3,288 |
194 |
$364K |
| D1120 |
Prophylaxis - child |
9,905 |
9,821 |
$361K |
| D1206 |
Topical application of fluoride varnish |
19,521 |
19,282 |
$334K |
| D0330 |
Panoramic radiographic image |
6,483 |
6,374 |
$308K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,558 |
2,856 |
$288K |
| T2022 |
Case management, per month |
602 |
588 |
$228K |
| D9450 |
|
1,722 |
1,685 |
$210K |
| D0274 |
Bitewings - four radiographic images |
6,027 |
5,966 |
$182K |
| 99408 |
|
602 |
587 |
$161K |
| H0047 |
Alcohol and/or other drug abuse services, not otherwise specified |
602 |
587 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,644 |
2,606 |
$152K |
| D0140 |
Limited oral evaluation - problem focused |
3,588 |
3,473 |
$119K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,661 |
4,425 |
$118K |
| D8660 |
|
3,748 |
3,682 |
$104K |
| D0470 |
|
2,410 |
2,378 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
712 |
380 |
$78K |
| H2021 |
Community-based wrap-around services, per 15 minutes |
530 |
183 |
$72K |
| D0340 |
|
3,159 |
3,119 |
$63K |
| D0272 |
Bitewings - two radiographic images |
3,164 |
3,144 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
4,114 |
3,984 |
$49K |
| D1351 |
Sealant - per tooth |
1,929 |
660 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
399 |
393 |
$34K |
| D8999 |
|
48 |
47 |
$17K |
| D1330 |
|
718 |
696 |
$15K |
| D8703 |
|
86 |
82 |
$12K |
| D4341 |
|
48 |
26 |
$8K |
| D3120 |
|
353 |
299 |
$7K |
| D8692 |
|
55 |
40 |
$7K |
| D1310 |
|
216 |
210 |
$5K |
| H0015 |
Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education |
48 |
12 |
$5K |
| D8704 |
|
27 |
27 |
$4K |
| Q3014 |
Telehealth originating site facility fee |
254 |
213 |
$3K |
| G9007 |
Coordinated care fee, scheduled team conference |
73 |
31 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
242 |
150 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
13 |
12 |
$2K |
| D1525 |
|
14 |
14 |
$2K |
| D0190 |
|
84 |
84 |
$1K |
| D2330 |
|
17 |
12 |
$1K |
| D9920 |
|
37 |
37 |
$1K |
| D0270 |
|
83 |
81 |
$916.22 |
| D0191 |
|
63 |
63 |
$887.55 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
14 |
13 |
$700.00 |
| D9110 |
|
14 |
13 |
$455.00 |
| D1354 |
|
15 |
12 |
$359.80 |
| D0350 |
|
2,404 |
2,390 |
$0.00 |
| D9986 |
|
249 |
241 |
$0.00 |
| D9996 |
|
85 |
85 |
$0.00 |