| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,330 |
4,159 |
$606K |
| D1110 |
Prophylaxis - adult |
1,554 |
1,498 |
$283K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
653 |
558 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
845 |
794 |
$98K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
433 |
412 |
$82K |
| D1120 |
Prophylaxis - child |
483 |
459 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
450 |
317 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
854 |
814 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
715 |
336 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
310 |
$42K |
| D1351 |
Sealant - per tooth |
581 |
151 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,682 |
1,613 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
75 |
$14K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
105 |
105 |
$8K |
| D0274 |
Bitewings - four radiographic images |
347 |
331 |
$6K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
635 |
582 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$217.87 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
14 |
13 |
$56.25 |
| D0190 |
|
15 |
15 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
17 |
17 |
$0.00 |
| 99173 |
|
15 |
15 |
$0.00 |
| 92551 |
|
15 |
15 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
154 |
136 |
$0.00 |
| D0603 |
|
25 |
25 |
$0.00 |
| 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 |
17 |
16 |
$0.00 |
| 90686 |
|
61 |
61 |
$0.00 |