| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,777 |
991 |
$106K |
| 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 |
1,545 |
1,418 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
1,540 |
1,444 |
$45K |
| D1110 |
Prophylaxis - adult |
1,059 |
1,035 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
527 |
517 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
316 |
306 |
$18K |
| D1120 |
Prophylaxis - child |
540 |
525 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
138 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
205 |
168 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,217 |
1,169 |
$15K |
| D1206 |
Topical application of fluoride varnish |
626 |
611 |
$12K |
| D0274 |
Bitewings - four radiographic images |
432 |
420 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
446 |
437 |
$10K |
| G0470 |
Federally qualified health center (fqhc) visit, mental health, established patient; a medically-necessary, face-to-face mental health 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 mental health visit |
111 |
88 |
$8K |
| D1351 |
Sealant - per tooth |
168 |
55 |
$4K |
| D0191 |
|
340 |
331 |
$3K |
| 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 |
47 |
47 |
$3K |
| D2330 |
|
39 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
80 |
79 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
182 |
142 |
$1K |
| D0270 |
|
94 |
93 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
69 |
69 |
$980.00 |
| D4355 |
|
29 |
29 |
$912.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,075 |
985 |
$177.50 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
61 |
60 |
$35.00 |
| 80305 |
|
147 |
128 |
$8.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
102 |
101 |
$0.00 |
| 90834 |
Psychotherapy, 45 minutes with patient |
19 |
17 |
$0.00 |
| D1330 |
|
514 |
511 |
$0.00 |
| 59430 |
|
12 |
12 |
$0.00 |
| 94760 |
|
13 |
12 |
$0.00 |
| 81025 |
|
293 |
288 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
15 |
$0.00 |
| D9991 |
|
33 |
33 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
49 |
47 |
$0.00 |