| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
10,282 |
8,834 |
$2.08M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,685 |
1,406 |
$49K |
| 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 |
1,825 |
1,461 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
223 |
69 |
$115.57 |
| D0220 |
Intraoral - periapical first radiographic image |
865 |
818 |
$89.12 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
33 |
13 |
$54.57 |
| D0140 |
Limited oral evaluation - problem focused |
581 |
548 |
$28.94 |
| D1110 |
Prophylaxis - adult |
696 |
696 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
318 |
318 |
$0.00 |
| D0330 |
Panoramic radiographic image |
163 |
163 |
$0.00 |
| D0270 |
|
32 |
32 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
221 |
$0.00 |
| D1330 |
|
376 |
375 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
477 |
477 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
58 |
58 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$0.00 |