| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H0019 |
Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem |
1,998 |
608 |
$4.77M |
| D7140 |
Extraction, erupted tooth or exposed root |
1,640 |
979 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
2,321 |
2,239 |
$30K |
| D0330 |
Panoramic radiographic image |
1,674 |
1,645 |
$23K |
| D1110 |
Prophylaxis - adult |
630 |
612 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
384 |
243 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
243 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
661 |
639 |
$2K |
| D0160 |
|
160 |
160 |
$2K |
| D0274 |
Bitewings - four radiographic images |
173 |
166 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
97 |
97 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
263 |
160 |
$679.25 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$416.00 |