| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,873 |
7,627 |
$1.60M |
| D1208 |
Topical application of fluoride, excluding varnish |
16,375 |
15,786 |
$1.40M |
| D1110 |
Prophylaxis - adult |
4,294 |
4,130 |
$970K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,588 |
3,282 |
$875K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,348 |
3,004 |
$796K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,633 |
2,507 |
$406K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,255 |
1,582 |
$400K |
| D0330 |
Panoramic radiographic image |
1,742 |
1,671 |
$388K |
| D0120 |
Periodic oral evaluation - established patient |
6,766 |
6,543 |
$223K |
| D0140 |
Limited oral evaluation - problem focused |
995 |
940 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
938 |
695 |
$142K |
| D0274 |
Bitewings - four radiographic images |
5,424 |
5,220 |
$142K |
| 90832 |
Psychotherapy, 30 minutes with patient |
366 |
293 |
$82K |
| D1354 |
|
4,450 |
1,247 |
$73K |
| 90834 |
Psychotherapy, 45 minutes with patient |
275 |
233 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
272 |
223 |
$55K |
| D1351 |
Sealant - per tooth |
17,195 |
3,618 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,043 |
1,015 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
80 |
$19K |
| 99382 |
|
51 |
51 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
65 |
$14K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
35 |
35 |
$11K |
| D0272 |
Bitewings - two radiographic images |
3,319 |
3,193 |
$10K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
43 |
41 |
$9K |
| 90837 |
Psychotherapy, 53 minutes with patient |
31 |
26 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
4,167 |
3,902 |
$7K |
| D2335 |
|
32 |
28 |
$6K |
| D4341 |
|
25 |
14 |
$5K |
| 90791 |
Psychiatric diagnostic evaluation |
14 |
14 |
$4K |
| D4910 |
|
12 |
12 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
351 |
330 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,537 |
2,624 |
$945.20 |
| 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 |
1,236 |
1,060 |
$834.15 |
| 83655 |
|
81 |
66 |
$428.86 |
| D0191 |
|
6,701 |
6,475 |
$270.65 |
| D0270 |
|
123 |
117 |
$270.65 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
183 |
177 |
$202.77 |
| 85018 |
|
68 |
54 |
$60.38 |
| 90686 |
|
73 |
70 |
$43.04 |
| 36415 |
Collection of venous blood by venipuncture |
650 |
605 |
$2.55 |
| 81003 |
|
81 |
77 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
29 |
28 |
$0.00 |
| 90710 |
|
12 |
12 |
$0.00 |
| 91322 |
|
22 |
21 |
$0.00 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
12 |
12 |
$0.00 |
| D0999 |
Unspecified diagnostic procedure, by report |
15,905 |
14,981 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
168 |
162 |
$0.00 |
| D0602 |
|
38 |
38 |
$0.00 |
| D1330 |
|
131 |
131 |
$0.00 |
| 90696 |
|
12 |
12 |
$0.00 |
| 90480 |
|
23 |
22 |
$0.00 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
90 |
85 |
$0.00 |
| D0603 |
|
15 |
15 |
$0.00 |
| D1310 |
|
114 |
114 |
$0.00 |
| 96127 |
|
36 |
30 |
$0.00 |