| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
6,805 |
5,260 |
$1.35M |
| D7140 |
Extraction, erupted tooth or exposed root |
1,214 |
512 |
$17K |
| D1110 |
Prophylaxis - adult |
1,336 |
1,288 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,354 |
1,178 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
734 |
485 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
495 |
335 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
1,608 |
1,538 |
$7K |
| D1351 |
Sealant - per tooth |
409 |
132 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
765 |
736 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
900 |
852 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
250 |
239 |
$6K |
| D1120 |
Prophylaxis - child |
654 |
626 |
$6K |
| D0274 |
Bitewings - four radiographic images |
1,016 |
973 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
255 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,499 |
1,409 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
140 |
97 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
537 |
509 |
$2K |
| 90834 |
Psychotherapy, 45 minutes with patient |
48 |
26 |
$1K |
| 90832 |
Psychotherapy, 30 minutes with patient |
126 |
48 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
53 |
$1K |
| D0191 |
|
83 |
82 |
$876.06 |
| D0230 |
Intraoral - periapical each additional radiographic image |
329 |
297 |
$677.48 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$0.00 |
| 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 |
94 |
89 |
$0.00 |
| D5899 |
|
29 |
12 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
34 |
24 |
$0.00 |