| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,350 |
4,171 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,925 |
4,735 |
$116K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,526 |
817 |
$101K |
| D1110 |
Prophylaxis - adult |
1,710 |
1,658 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,260 |
3,118 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
780 |
513 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,374 |
1,324 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,909 |
1,836 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
708 |
687 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,348 |
1,303 |
$33K |
| D0330 |
Panoramic radiographic image |
867 |
834 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
629 |
595 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
138 |
$13K |
| D1351 |
Sealant - per tooth |
473 |
149 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
861 |
694 |
$11K |
| D0272 |
Bitewings - two radiographic images |
599 |
556 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
592 |
559 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
490 |
346 |
$3K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
197 |
190 |
$849.47 |
| D1354 |
|
50 |
24 |
$433.71 |
| 36415 |
Collection of venous blood by venipuncture |
297 |
227 |
$311.49 |
| 96127 |
|
515 |
396 |
$291.15 |
| 99173 |
|
34 |
31 |
$37.74 |
| 92551 |
|
34 |
31 |
$28.01 |
| D1330 |
|
6,613 |
6,376 |
$26.00 |
| 81025 |
|
18 |
12 |
$2.43 |
| 3074F |
|
463 |
317 |
$0.05 |
| 3079F |
|
274 |
188 |
$0.04 |
| 3075F |
|
26 |
16 |
$0.01 |
| 3078F |
|
166 |
110 |
$0.01 |
| D1310 |
|
757 |
734 |
$0.00 |
| 3008F |
|
1,234 |
892 |
$0.00 |
| D1320 |
|
14 |
14 |
$0.00 |
| 1159F |
|
1,309 |
980 |
$0.00 |
| 1160F |
|
1,333 |
968 |
$0.00 |
| 3077F |
|
14 |
12 |
$0.00 |