| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,728 |
1,278 |
$335K |
| D0120 |
Periodic oral evaluation - established patient |
8,813 |
8,267 |
$148K |
| D1110 |
Prophylaxis - adult |
7,028 |
6,542 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,309 |
2,016 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,386 |
3,223 |
$80K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,580 |
1,815 |
$79K |
| D1206 |
Topical application of fluoride varnish |
5,424 |
5,140 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
9,870 |
9,123 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,086 |
1,499 |
$73K |
| D1120 |
Prophylaxis - child |
4,820 |
4,559 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
2,478 |
2,347 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
13,571 |
12,608 |
$51K |
| D0274 |
Bitewings - four radiographic images |
5,144 |
4,817 |
$42K |
| D1351 |
Sealant - per tooth |
1,734 |
350 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,159 |
3,605 |
$14K |
| D0601 |
|
836 |
780 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
111 |
$6K |
| D2140 |
|
106 |
80 |
$4K |
| D2330 |
|
94 |
66 |
$4K |
| D2335 |
|
52 |
43 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
40 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
247 |
247 |
$1K |
| D9110 |
|
299 |
164 |
$1K |
| D0603 |
|
125 |
125 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
48 |
48 |
$720.00 |
| D0602 |
|
70 |
70 |
$620.00 |
| D4355 |
|
179 |
165 |
$549.00 |
| D0190 |
|
68 |
68 |
$340.00 |
| D0270 |
|
63 |
63 |
$217.35 |
| 90834 |
Psychotherapy, 45 minutes with patient |
431 |
321 |
$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 |
14 |
13 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$0.00 |
| D1310 |
|
153 |
152 |
$0.00 |
| 90837 |
Psychotherapy, 53 minutes with patient |
364 |
257 |
$0.00 |
| D1999 |
|
614 |
440 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$0.00 |
| 90832 |
Psychotherapy, 30 minutes with patient |
47 |
34 |
$0.00 |
| 90791 |
Psychiatric diagnostic evaluation |
29 |
29 |
$0.00 |