| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,404 |
1,343 |
$81K |
| D1206 |
Topical application of fluoride varnish |
3,197 |
3,051 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
973 |
812 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,573 |
1,543 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,826 |
1,630 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
972 |
791 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
960 |
919 |
$49K |
| D1110 |
Prophylaxis - adult |
766 |
739 |
$45K |
| D1120 |
Prophylaxis - child |
954 |
927 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,432 |
2,343 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
788 |
740 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,242 |
1,214 |
$26K |
| D4341 |
|
199 |
144 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
57 |
$16K |
| D4910 |
|
227 |
224 |
$11K |
| D1351 |
Sealant - per tooth |
214 |
75 |
$7K |
| D4342 |
|
53 |
40 |
$4K |
| D0330 |
Panoramic radiographic image |
197 |
185 |
$4K |
| D0270 |
|
207 |
197 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
95 |
90 |
$1K |
| D0240 |
|
48 |
25 |
$324.00 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$252.28 |
| D1320 |
|
19 |
13 |
$192.13 |
| 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 |
2,646 |
2,056 |
$27.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
868 |
686 |
$0.00 |
| D0601 |
|
309 |
307 |
$0.00 |
| D1310 |
|
3,973 |
3,744 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
442 |
363 |
$0.00 |
| D1330 |
|
6,614 |
5,830 |
$0.00 |
| D0602 |
|
1,116 |
1,081 |
$0.00 |
| D0603 |
|
1,144 |
1,102 |
$0.00 |