| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,700 |
1,654 |
$61K |
| D1110 |
Prophylaxis - adult |
860 |
820 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,558 |
1,510 |
$12K |
| D1120 |
Prophylaxis - child |
235 |
230 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
532 |
514 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
77 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
73 |
58 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
346 |
343 |
$4K |
| D1206 |
Topical application of fluoride varnish |
1,429 |
1,361 |
$4K |
| D1351 |
Sealant - per tooth |
166 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
2,361 |
2,280 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,225 |
2,025 |
$946.94 |
| D1330 |
|
1,213 |
1,157 |
$724.16 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$621.38 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$460.34 |
| D0272 |
Bitewings - two radiographic images |
275 |
266 |
$440.00 |
| 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 |
103 |
73 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
13 |
$0.00 |