| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
15,782 |
14,353 |
$3.67M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
10,811 |
8,849 |
$1.87M |
| D0120 |
Periodic oral evaluation - established patient |
8,968 |
8,793 |
$1.84M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,040 |
4,903 |
$1.22M |
| D5899 |
|
4,382 |
2,892 |
$887K |
| 90834 |
Psychotherapy, 45 minutes with patient |
4,142 |
1,623 |
$716K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,231 |
4,681 |
$650K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,042 |
3,229 |
$574K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
3,226 |
2,344 |
$522K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,898 |
2,798 |
$491K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,634 |
1,402 |
$313K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,491 |
1,336 |
$228K |
| D2330 |
|
1,895 |
1,185 |
$194K |
| D2331 |
|
1,116 |
889 |
$137K |
| 90832 |
Psychotherapy, 30 minutes with patient |
477 |
183 |
$81K |
| D2335 |
|
474 |
412 |
$72K |
| T1015 |
Clinic visit/encounter, all-inclusive |
327 |
250 |
$68K |
| D2394 |
|
380 |
361 |
$48K |
| 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 |
714 |
585 |
$48K |
| D2332 |
|
298 |
265 |
$44K |
| 90837 |
Psychotherapy, 53 minutes with patient |
222 |
106 |
$40K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
155 |
115 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
29 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
24 |
24 |
$6K |
| 99215 |
Prolong outpt/office vis |
16 |
13 |
$3K |
| D9110 |
|
274 |
247 |
$2K |
| D2160 |
|
41 |
33 |
$2K |
| D5110 |
|
12 |
12 |
$2K |
| D1354 |
|
188 |
119 |
$2K |
| D2140 |
|
50 |
28 |
$2K |
| 80047 |
|
1,505 |
1,345 |
$1K |
| D2940 |
|
30 |
25 |
$1K |
| 36415 |
Collection of venous blood by venipuncture |
2,948 |
2,614 |
$863.33 |
| D1110 |
Prophylaxis - adult |
9,599 |
9,348 |
$756.35 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
1,087 |
994 |
$476.45 |
| D0274 |
Bitewings - four radiographic images |
11,043 |
10,773 |
$416.50 |
| D0330 |
Panoramic radiographic image |
8,361 |
8,100 |
$405.88 |
| D1206 |
Topical application of fluoride varnish |
9,664 |
9,431 |
$300.34 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
754 |
662 |
$273.97 |
| D0220 |
Intraoral - periapical first radiographic image |
8,497 |
7,936 |
$177.58 |
| D4355 |
|
255 |
248 |
$105.00 |
| 80306 |
|
154 |
135 |
$68.87 |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,360 |
3,116 |
$36.79 |
| 90686 |
|
111 |
102 |
$25.00 |
| D1120 |
Prophylaxis - child |
1,742 |
1,706 |
$22.25 |
| D0272 |
Bitewings - two radiographic images |
700 |
681 |
$12.89 |
| 0011A |
|
98 |
90 |
$0.00 |
| D1351 |
Sealant - per tooth |
252 |
88 |
$0.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
292 |
260 |
$0.00 |
| 0012A |
|
97 |
96 |
$0.00 |
| 0013A |
|
50 |
47 |
$0.00 |
| 90658 |
|
79 |
74 |
$0.00 |