| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
487 |
482 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
394 |
390 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
222 |
146 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
244 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
82 |
$12K |
| D1110 |
Prophylaxis - adult |
178 |
176 |
$11K |
| 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 |
202 |
195 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
241 |
241 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
179 |
$5K |
| D0274 |
Bitewings - four radiographic images |
172 |
172 |
$4K |
| D1206 |
Topical application of fluoride varnish |
133 |
133 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
241 |
234 |
$3K |
| D1120 |
Prophylaxis - child |
63 |
63 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
122 |
119 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
124 |
40 |
$723.78 |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$238.23 |
| D0270 |
|
12 |
12 |
$121.40 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
53 |
52 |
$0.00 |
| 0001F |
|
200 |
196 |
$0.00 |