| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0999 |
Unspecified diagnostic procedure, by report |
5,919 |
5,049 |
$828K |
| T1015 |
Clinic visit/encounter, all-inclusive |
2,206 |
969 |
$363K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
652 |
521 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
119 |
$23K |
| 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 |
871 |
789 |
$16K |
| D1110 |
Prophylaxis - adult |
901 |
901 |
$0.00 |
| D1120 |
Prophylaxis - child |
692 |
692 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
117 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
896 |
896 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
667 |
446 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
386 |
386 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
154 |
154 |
$0.00 |
| D1351 |
Sealant - per tooth |
102 |
29 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,048 |
1,048 |
$0.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
376 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$0.00 |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
30 |
29 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$0.00 |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
285 |
282 |
$-32.17 |