| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99499 |
|
12,615 |
10,796 |
$1.28M |
| D7999 |
|
19,470 |
4,566 |
$500K |
| D1110 |
Prophylaxis - adult |
734 |
719 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
1,699 |
1,667 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
184 |
150 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
507 |
$15K |
| D0274 |
Bitewings - four radiographic images |
642 |
642 |
$14K |
| D0330 |
Panoramic radiographic image |
394 |
386 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
459 |
459 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
596 |
585 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
107 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
56 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
174 |
171 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
342 |
$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 |
107 |
40 |
$3K |
| T2022 |
Case management, per month |
19 |
19 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
15 |
$2K |
| D0270 |
|
103 |
103 |
$1K |
| D0160 |
|
14 |
13 |
$943.66 |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
48 |
42 |
$804.04 |
| D1330 |
|
29 |
25 |
$203.58 |