| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0190 |
|
8,301 |
7,966 |
$382K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,154 |
3,492 |
$319K |
| H1000 |
Prenatal care, at-risk assessment |
3,054 |
2,513 |
$302K |
| D1110 |
Prophylaxis - adult |
2,427 |
2,362 |
$165K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,669 |
1,487 |
$165K |
| D1120 |
Prophylaxis - child |
2,248 |
2,152 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,962 |
3,867 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,081 |
3,017 |
$128K |
| D0274 |
Bitewings - four radiographic images |
2,455 |
2,400 |
$103K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,532 |
3,032 |
$101K |
| D1351 |
Sealant - per tooth |
2,808 |
1,220 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
558 |
480 |
$55K |
| D1206 |
Topical application of fluoride varnish |
11,078 |
10,668 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
689 |
689 |
$39K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
396 |
347 |
$24K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
2,569 |
2,425 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
541 |
532 |
$17K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
260 |
208 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
54 |
$8K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
503 |
452 |
$7K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
103 |
82 |
$6K |
| D0272 |
Bitewings - two radiographic images |
2,471 |
2,401 |
$6K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
117 |
95 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
5,906 |
5,732 |
$5K |
| D2330 |
|
102 |
84 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
220 |
213 |
$3K |
| D2331 |
|
27 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,173 |
5,034 |
$3K |
| D1330 |
|
4,809 |
4,646 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
127 |
127 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
40 |
26 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
38 |
36 |
$3K |
| D1354 |
|
51 |
45 |
$2K |
| 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 |
943 |
706 |
$1K |
| 59025 |
Fetal non-stress test |
66 |
27 |
$843.83 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
35 |
32 |
$592.76 |
| 99188 |
|
33 |
33 |
$452.08 |
| 99381 |
|
13 |
12 |
$431.59 |
| 90686 |
|
589 |
559 |
$425.40 |
| D1355 |
|
114 |
114 |
$378.45 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
13 |
13 |
$319.67 |
| G0439 |
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit |
16 |
12 |
$225.00 |
| D0240 |
|
12 |
12 |
$142.68 |
| 81003 |
|
13 |
13 |
$26.38 |
| 90656 |
|
48 |
48 |
$18.13 |
| 1159F |
|
122 |
83 |
$0.05 |
| 3008F |
|
9,766 |
8,618 |
$0.03 |
| 1036F |
|
382 |
321 |
$0.00 |
| 3074F |
|
342 |
302 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
263 |
234 |
$0.00 |
| 1157F |
|
12 |
12 |
$0.00 |
| 92551 |
|
1,427 |
1,203 |
$0.00 |
| 1000F |
|
832 |
683 |
$0.00 |
| 90674 |
|
131 |
131 |
$0.00 |
| 90697 |
|
24 |
14 |
$0.00 |
| 0513F |
|
109 |
73 |
$0.00 |
| 1111F |
|
71 |
44 |
$0.00 |
| 3079F |
|
25 |
24 |
$0.00 |
| 1126F |
|
27 |
14 |
$0.00 |
| 90651 |
|
20 |
12 |
$0.00 |
| 3351F |
|
14 |
13 |
$0.00 |
| 99173 |
|
1,871 |
1,635 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
198 |
160 |
$0.00 |
| 3725F |
|
248 |
216 |
$0.00 |
| 0502F |
|
28 |
27 |
$0.00 |
| 1158F |
|
13 |
13 |
$0.00 |
| 1160F |
|
108 |
70 |
$0.00 |
| 3078F |
|
209 |
160 |
$0.00 |
| 1039F |
|
13 |
13 |
$0.00 |
| 4004F |
|
66 |
65 |
$0.00 |
| 3015F |
|
12 |
12 |
$0.00 |
| G0468 |
Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv |
18 |
14 |
$0.00 |
| 0521F |
|
24 |
12 |
$0.00 |
| 90633 |
|
23 |
13 |
$0.00 |
| 90670 |
|
16 |
16 |
$0.00 |
| 90671 |
|
29 |
17 |
$0.00 |