| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9450 |
|
34,073 |
20,667 |
$1.16M |
| T1015 |
Clinic visit/encounter, all-inclusive |
3,966 |
3,342 |
$488K |
| 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 |
12,994 |
11,112 |
$401K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,036 |
3,346 |
$400K |
| D0140 |
Limited oral evaluation - problem focused |
11,409 |
6,484 |
$251K |
| D1110 |
Prophylaxis - adult |
7,854 |
5,065 |
$247K |
| D0210 |
Intraoral - complete series of radiographic images |
4,532 |
2,929 |
$190K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,927 |
1,625 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,078 |
3,455 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,154 |
1,490 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
6,136 |
4,356 |
$94K |
| D0220 |
Intraoral - periapical first radiographic image |
11,153 |
6,327 |
$92K |
| D2740 |
Crown - porcelain/ceramic |
146 |
93 |
$87K |
| D1120 |
Prophylaxis - child |
1,477 |
1,380 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,416 |
1,840 |
$65K |
| D1206 |
Topical application of fluoride varnish |
1,675 |
1,569 |
$41K |
| D0330 |
Panoramic radiographic image |
718 |
604 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
594 |
377 |
$36K |
| D2330 |
|
753 |
339 |
$32K |
| D2331 |
|
572 |
282 |
$29K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
1,801 |
1,566 |
$24K |
| D9110 |
|
613 |
359 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,772 |
737 |
$12K |
| D1351 |
Sealant - per tooth |
247 |
55 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
93 |
40 |
$9K |
| D2335 |
|
55 |
39 |
$7K |
| D2332 |
|
65 |
47 |
$6K |
| D4341 |
|
38 |
13 |
$5K |
| D0180 |
|
97 |
95 |
$3K |
| D0272 |
Bitewings - two radiographic images |
117 |
107 |
$3K |
| D2950 |
|
20 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
81 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
17 |
16 |
$906.78 |
| D0270 |
|
40 |
39 |
$487.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$324.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
43 |
42 |
$182.30 |
| 90658 |
|
14 |
14 |
$159.18 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
5,226 |
5,019 |
$38.74 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
518 |
518 |
$1.08 |
| 99072 |
|
199 |
187 |
$0.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
1,752 |
983 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
83 |
81 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,299 |
4,995 |
$0.00 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
503 |
503 |
$0.00 |
| 90674 |
|
15 |
15 |
$0.00 |
| D9310 |
|
222 |
190 |
$0.00 |
| D1320 |
|
116 |
97 |
$0.00 |
| D1330 |
|
358 |
313 |
$0.00 |