| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
300 |
142 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
611 |
585 |
$15K |
| D1110 |
Prophylaxis - adult |
221 |
214 |
$9K |
| D1120 |
Prophylaxis - child |
184 |
180 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
254 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
189 |
182 |
$5K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
82 |
71 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
74 |
$4K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
123 |
109 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
165 |
$4K |
| 90677 |
|
32 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
116 |
$1K |
| D1351 |
Sealant - per tooth |
46 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
56 |
51 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
307 |
236 |
$1K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
17 |
17 |
$1K |
| D0272 |
Bitewings - two radiographic images |
46 |
46 |
$804.90 |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$558.65 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$446.97 |
| D1354 |
|
37 |
13 |
$322.95 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
22 |
15 |
$291.42 |
| 96127 |
|
367 |
256 |
$213.01 |
| 90832 |
Psychotherapy, 30 minutes with patient |
82 |
39 |
$203.52 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
20 |
15 |
$201.60 |
| 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 |
$190.74 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
114 |
101 |
$100.04 |
| 97802 |
|
23 |
13 |
$92.04 |
| 90461 |
|
58 |
50 |
$56.30 |
| 99442 |
|
101 |
90 |
$30.15 |
| 81003 |
|
447 |
268 |
$24.16 |
| 99173 |
|
14 |
13 |
$23.50 |
| 92551 |
|
14 |
13 |
$21.27 |
| 96161 |
|
32 |
24 |
$12.84 |
| 1159F |
|
1,419 |
1,035 |
$0.01 |
| 3008F |
|
1,104 |
732 |
$0.01 |
| 1160F |
|
1,471 |
1,037 |
$0.00 |
| 3078F |
|
472 |
307 |
$0.00 |
| 0502F |
|
263 |
156 |
$0.00 |
| D1330 |
|
1,363 |
1,295 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
39 |
36 |
$0.00 |
| D1310 |
|
392 |
375 |
$0.00 |
| 3074F |
|
548 |
338 |
$0.00 |
| 3079F |
|
72 |
44 |
$0.00 |
| 90686 |
|
14 |
12 |
$0.00 |