| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0190 |
|
7,644 |
7,351 |
$367K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,666 |
3,242 |
$309K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,064 |
4,365 |
$308K |
| D1120 |
Prophylaxis - child |
4,842 |
4,823 |
$272K |
| D1110 |
Prophylaxis - adult |
3,665 |
3,656 |
$268K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,505 |
5,364 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
6,967 |
6,856 |
$198K |
| D1351 |
Sealant - per tooth |
6,673 |
2,896 |
$172K |
| D0274 |
Bitewings - four radiographic images |
4,482 |
4,403 |
$143K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,001 |
4,247 |
$111K |
| D1206 |
Topical application of fluoride varnish |
16,029 |
15,690 |
$78K |
| D0140 |
Limited oral evaluation - problem focused |
889 |
862 |
$29K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
299 |
294 |
$24K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,568 |
2,468 |
$20K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
267 |
227 |
$17K |
| D0272 |
Bitewings - two radiographic images |
5,600 |
5,512 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
185 |
178 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
11,796 |
11,514 |
$10K |
| D1330 |
|
8,995 |
8,947 |
$8K |
| D9999 |
Unspecified adjunctive procedure, by report |
380 |
380 |
$7K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
580 |
535 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,758 |
10,538 |
$7K |
| D7111 |
|
214 |
177 |
$7K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
210 |
177 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
896 |
729 |
$5K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
62 |
53 |
$4K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
55 |
36 |
$4K |
| D1999 |
|
61 |
61 |
$4K |
| H1000 |
Prenatal care, at-risk assessment |
85 |
71 |
$3K |
| 99188 |
|
138 |
129 |
$2K |
| 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 |
2,757 |
2,078 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| 99215 |
Prolong outpt/office vis |
17 |
16 |
$965.87 |
| 0012A |
|
18 |
18 |
$640.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
17 |
$340.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
30 |
24 |
$315.58 |
| D1355 |
|
88 |
88 |
$226.17 |
| 90686 |
|
561 |
545 |
$165.94 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
13 |
13 |
$129.12 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
21 |
13 |
$129.09 |
| 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 |
302 |
253 |
$118.78 |
| 81003 |
|
46 |
45 |
$87.72 |
| 99173 |
|
1,970 |
1,797 |
$20.00 |
| 3078F |
|
229 |
176 |
$0.04 |
| 3074F |
|
384 |
337 |
$0.03 |
| 3008F |
|
9,929 |
8,805 |
$0.02 |
| 1000F |
|
967 |
798 |
$0.02 |
| 1036F |
|
365 |
294 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
230 |
208 |
$0.00 |
| 92551 |
|
1,526 |
1,377 |
$0.00 |
| 3353F |
|
13 |
13 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
265 |
223 |
$0.00 |
| 0513F |
|
124 |
95 |
$0.00 |
| 1111F |
|
38 |
38 |
$0.00 |
| 3014F |
|
17 |
12 |
$0.00 |
| 90674 |
|
46 |
46 |
$0.00 |
| 3079F |
|
30 |
27 |
$0.00 |
| 1038F |
|
14 |
14 |
$0.00 |
| 1034F |
|
15 |
13 |
$0.00 |
| 1126F |
|
31 |
14 |
$0.00 |
| 90656 |
|
16 |
16 |
$0.00 |
| 1159F |
|
124 |
121 |
$0.00 |
| 1160F |
|
100 |
97 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
202 |
135 |
$0.00 |
| 3725F |
|
246 |
200 |
$0.00 |
| 4004F |
|
72 |
70 |
$0.00 |
| 3015F |
|
21 |
17 |
$0.00 |
| 90633 |
|
12 |
12 |
$0.00 |
| 0502F |
|
66 |
53 |
$0.00 |
| 90655 |
|
26 |
26 |
$0.00 |
| 90670 |
|
21 |
13 |
$0.00 |