| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,698 |
1,679 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,014 |
737 |
$70K |
| D1110 |
Prophylaxis - adult |
983 |
978 |
$43K |
| D0330 |
Panoramic radiographic image |
613 |
609 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
638 |
455 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
2,230 |
2,193 |
$19K |
| D1351 |
Sealant - per tooth |
1,314 |
445 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,009 |
998 |
$17K |
| D1206 |
Topical application of fluoride varnish |
2,704 |
2,672 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
475 |
469 |
$9K |
| 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 |
558 |
428 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
456 |
451 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
77 |
66 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
462 |
434 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,302 |
1,289 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,149 |
3,084 |
$3K |
| D1330 |
|
2,720 |
2,694 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,766 |
2,636 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
62 |
54 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
13 |
$1K |