| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
6,328 |
2,885 |
$431K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,336 |
2,771 |
$263K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,787 |
7,770 |
$259K |
| D1351 |
Sealant - per tooth |
14,414 |
2,947 |
$250K |
| D0330 |
Panoramic radiographic image |
4,506 |
3,823 |
$219K |
| D0140 |
Limited oral evaluation - problem focused |
5,565 |
4,719 |
$184K |
| D1206 |
Topical application of fluoride varnish |
9,458 |
8,312 |
$149K |
| D1110 |
Prophylaxis - adult |
3,555 |
3,147 |
$143K |
| D1120 |
Prophylaxis - child |
4,444 |
3,974 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
6,390 |
5,669 |
$111K |
| D0274 |
Bitewings - four radiographic images |
4,516 |
3,813 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,326 |
1,657 |
$108K |
| D0210 |
Intraoral - complete series of radiographic images |
3,255 |
2,626 |
$82K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,174 |
1,034 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
879 |
683 |
$62K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
775 |
700 |
$56K |
| T1015 |
Clinic visit/encounter, all-inclusive |
3,003 |
2,657 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,900 |
3,305 |
$42K |
| D9999 |
Unspecified adjunctive procedure, by report |
13,863 |
10,251 |
$41K |
| D2331 |
|
377 |
269 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,126 |
898 |
$31K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
197 |
123 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,180 |
1,085 |
$21K |
| D2330 |
|
303 |
219 |
$19K |
| D2335 |
|
92 |
67 |
$14K |
| D0240 |
|
1,079 |
453 |
$13K |
| D0145 |
Oral evaluation for a patient under three years of age |
521 |
483 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
154 |
99 |
$11K |
| D2332 |
|
46 |
36 |
$5K |
| D4355 |
|
68 |
53 |
$5K |
| D4346 |
|
26 |
26 |
$3K |
| 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 |
84 |
75 |
$2K |
| D4910 |
|
55 |
53 |
$2K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
371 |
344 |
$2K |
| D1354 |
|
53 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
300 |
135 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
13 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
106 |
100 |
$1K |
| 36416 |
|
412 |
386 |
$962.21 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
13 |
12 |
$889.50 |
| D4341 |
|
20 |
12 |
$618.96 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
15 |
14 |
$273.00 |
| 90656 |
|
14 |
14 |
$76.73 |
| 85018 |
|
15 |
13 |
$27.47 |
| D0601 |
|
80 |
77 |
$0.00 |
| D0603 |
|
18 |
16 |
$0.00 |
| D0602 |
|
55 |
51 |
$0.00 |