| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
911 |
790 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,897 |
590 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,390 |
1,183 |
$34K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
456 |
419 |
$30K |
| D0274 |
Bitewings - four radiographic images |
369 |
336 |
$21K |
| 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 |
655 |
637 |
$19K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
173 |
161 |
$15K |
| 99307 |
|
806 |
771 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
142 |
136 |
$12K |
| D0330 |
Panoramic radiographic image |
107 |
97 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
143 |
133 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
91 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
17 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
121 |
120 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
41 |
40 |
$2K |
| 99382 |
|
57 |
57 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
16 |
15 |
$1K |