| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
13,911 |
12,221 |
$2.90M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
49 |
39 |
$1K |
| 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 |
76 |
62 |
$676.47 |
| D0140 |
Limited oral evaluation - problem focused |
1,656 |
1,588 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
232 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
143 |
143 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
811 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
115 |
115 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
104 |
$0.00 |
| D1330 |
|
236 |
226 |
$0.00 |
| D0240 |
|
80 |
42 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
39 |
14 |
$0.00 |
| D1351 |
Sealant - per tooth |
40 |
13 |
$0.00 |
| D1110 |
Prophylaxis - adult |
366 |
353 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
771 |
768 |
$0.00 |
| D0330 |
Panoramic radiographic image |
174 |
174 |
$0.00 |
| D9110 |
|
57 |
57 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
191 |
187 |
$0.00 |
| D1120 |
Prophylaxis - child |
327 |
327 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
12 |
$0.00 |