| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
66,199 |
56,514 |
$3.82M |
| D0140 |
Limited oral evaluation - problem focused |
14,402 |
12,578 |
$282.96 |
| D7140 |
Extraction, erupted tooth or exposed root |
8,402 |
4,820 |
$212.76 |
| D0220 |
Intraoral - periapical first radiographic image |
15,304 |
13,217 |
$114.57 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,947 |
1,321 |
$108.80 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,762 |
2,824 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,653 |
1,671 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
24,843 |
22,318 |
$0.00 |
| D1351 |
Sealant - per tooth |
6,704 |
1,963 |
$0.00 |
| D0240 |
|
4,232 |
2,453 |
$0.00 |
| D0602 |
|
48 |
48 |
$0.00 |
| D1310 |
|
1,920 |
1,895 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
8,165 |
7,287 |
$0.00 |
| D1330 |
|
1,978 |
1,950 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,256 |
3,778 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
11,330 |
10,122 |
$0.00 |
| D0603 |
|
1,866 |
1,851 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
516 |
440 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
423 |
$0.00 |
| 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 |
13 |
13 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$0.00 |
| 90686 |
|
21 |
20 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
89 |
86 |
$0.00 |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
38 |
26 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
36 |
$0.00 |
| D0601 |
|
16 |
16 |
$0.00 |
| D2330 |
|
21 |
12 |
$0.00 |
| D0190 |
|
12,582 |
11,862 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
1,883 |
1,660 |
$0.00 |
| D1110 |
Prophylaxis - adult |
2,667 |
2,381 |
$0.00 |
| D2950 |
|
308 |
239 |
$0.00 |
| D1354 |
|
4,448 |
1,458 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
3,123 |
2,813 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,761 |
1,730 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,059 |
2,461 |
$0.00 |
| D0270 |
|
2,075 |
1,882 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,650 |
898 |
$0.00 |
| D0330 |
Panoramic radiographic image |
3,407 |
3,032 |
$0.00 |
| D1120 |
Prophylaxis - child |
14,263 |
12,747 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
71 |
59 |
$0.00 |
| D2940 |
|
16 |
14 |
$0.00 |