| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,393 |
4,339 |
$159K |
| D0330 |
Panoramic radiographic image |
883 |
873 |
$32K |
| D1110 |
Prophylaxis - adult |
679 |
660 |
$19K |
| D0603 |
|
1,610 |
1,549 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
363 |
269 |
$14K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
199 |
170 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
363 |
261 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
237 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
802 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
605 |
434 |
$8K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
138 |
126 |
$7K |
| D1120 |
Prophylaxis - child |
433 |
425 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,340 |
1,596 |
$6K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
1,169 |
1,000 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
64 |
$4K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
576 |
455 |
$3K |
| D0602 |
|
92 |
90 |
$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 |
914 |
715 |
$2K |
| D1330 |
|
2,404 |
2,045 |
$2K |
| D1206 |
Topical application of fluoride varnish |
1,448 |
1,410 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
460 |
450 |
$2K |
| 99381 |
|
13 |
12 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
802 |
779 |
$1K |
| D0274 |
Bitewings - four radiographic images |
1,124 |
1,104 |
$1K |
| D4341 |
|
116 |
42 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,090 |
1,968 |
$865.31 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$724.59 |
| 90686 |
|
358 |
312 |
$431.88 |
| D0601 |
|
12 |
12 |
$317.86 |
| H1000 |
Prenatal care, at-risk assessment |
13 |
12 |
$271.40 |
| 82948 |
|
235 |
208 |
$123.87 |
| D0272 |
Bitewings - two radiographic images |
158 |
151 |
$94.08 |
| 3008F |
|
1,791 |
1,613 |
$31.47 |
| 90656 |
|
52 |
50 |
$22.35 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
29 |
25 |
$14.69 |
| 81002 |
|
170 |
123 |
$10.47 |
| 1160F |
|
236 |
213 |
$0.00 |
| 3078F |
|
566 |
521 |
$0.00 |
| 3725F |
|
1,756 |
1,596 |
$0.00 |
| 90670 |
|
83 |
64 |
$0.00 |
| D9993 |
|
1,581 |
1,553 |
$0.00 |
| 1159F |
|
242 |
217 |
$0.00 |
| 90633 |
|
31 |
25 |
$0.00 |
| 3074F |
|
798 |
757 |
$0.00 |
| D1310 |
|
2,062 |
1,726 |
$0.00 |
| 3044F |
|
63 |
55 |
$0.00 |
| 3351F |
|
1,664 |
1,517 |
$0.00 |
| 3079F |
|
167 |
150 |
$0.00 |
| 1111F |
|
25 |
24 |
$0.00 |
| 90697 |
|
19 |
15 |
$0.00 |
| G8510 |
Screening for depression is documented as negative, a follow-up plan is not required |
33 |
33 |
$0.00 |
| 3075F |
|
16 |
13 |
$0.00 |