| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
260 |
259 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
86 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
236 |
$10K |
| D1120 |
Prophylaxis - child |
176 |
176 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
90 |
90 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
194 |
194 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
34 |
28 |
$4K |
| D1206 |
Topical application of fluoride varnish |
150 |
150 |
$4K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
60 |
43 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
40 |
$669.62 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$463.91 |
| 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 |
81 |
71 |
$0.00 |