| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0190 |
|
2,538 |
2,534 |
$248K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,473 |
1,245 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,165 |
1,033 |
$236K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,265 |
2,259 |
$223K |
| D1110 |
Prophylaxis - adult |
1,533 |
1,527 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
3,266 |
3,251 |
$161K |
| D1120 |
Prophylaxis - child |
1,649 |
1,642 |
$141K |
| D1351 |
Sealant - per tooth |
2,570 |
1,183 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,947 |
4,888 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,288 |
2,278 |
$86K |
| D1206 |
Topical application of fluoride varnish |
5,231 |
5,216 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
532 |
514 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,194 |
1,813 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
91 |
$10K |
| D0272 |
Bitewings - two radiographic images |
2,339 |
2,329 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
5,559 |
5,498 |
$8K |
| 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 |
2,675 |
1,963 |
$4K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
40 |
36 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
636 |
605 |
$4K |
| D1330 |
|
3,302 |
3,289 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
80 |
79 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
727 |
613 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
84 |
84 |
$2K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
23 |
23 |
$2K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
111 |
107 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
27 |
27 |
$540.00 |
| H1000 |
Prenatal care, at-risk assessment |
12 |
12 |
$521.15 |
| 0064A |
|
18 |
15 |
$520.00 |
| 99215 |
Prolong outpt/office vis |
12 |
12 |
$425.81 |
| 99188 |
|
30 |
26 |
$334.74 |
| D1355 |
|
29 |
29 |
$296.67 |
| 90686 |
|
120 |
120 |
$170.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
19 |
12 |
$71.26 |
| 82962 |
|
17 |
14 |
$31.22 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
441 |
350 |
$0.00 |
| 99173 |
|
313 |
289 |
$0.00 |
| 4004F |
|
19 |
19 |
$0.00 |
| 3078F |
|
27 |
27 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
16 |
14 |
$0.00 |
| G0444 |
Annual depression screening, 5 to 15 minutes |
19 |
14 |
$0.00 |
| 90670 |
|
27 |
27 |
$0.00 |
| 1160F |
|
22 |
21 |
$0.00 |
| 1159F |
|
23 |
22 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 3008F |
|
2,062 |
1,926 |
$0.00 |
| 1000F |
|
95 |
93 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
417 |
329 |
$0.00 |
| 92551 |
|
233 |
221 |
$0.00 |
| 3074F |
|
53 |
41 |
$0.00 |
| 3079F |
|
12 |
12 |
$0.00 |
| 91306 |
|
17 |
14 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
49 |
43 |
$0.00 |
| 1170F |
|
22 |
21 |
$0.00 |
| 1036F |
|
24 |
24 |
$0.00 |
| 1034F |
|
13 |
12 |
$0.00 |
| 1125F |
|
12 |
12 |
$0.00 |