| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
588 |
585 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
708 |
703 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
253 |
218 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
219 |
125 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
490 |
488 |
$5K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
37 |
33 |
$2K |
| D0274 |
Bitewings - four radiographic images |
443 |
441 |
$2K |
| H1000 |
Prenatal care, at-risk assessment |
13 |
13 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31 |
28 |
$1K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
192 |
186 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
110 |
107 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
25 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
377 |
373 |
$632.67 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$333.48 |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
107 |
$294.72 |
| D0272 |
Bitewings - two radiographic images |
46 |
44 |
$201.24 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$141.78 |
| 99173 |
|
85 |
79 |
$0.00 |
| 1159F |
|
43 |
40 |
$0.00 |
| 1111F |
|
184 |
171 |
$0.00 |
| 3008F |
|
303 |
257 |
$0.00 |
| 2000F |
|
54 |
42 |
$0.00 |
| 2010F |
|
147 |
130 |
$0.00 |
| 1030F |
|
180 |
168 |
$0.00 |
| 2001F |
|
88 |
67 |
$0.00 |
| 1000F |
|
85 |
65 |
$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 |
87 |
62 |
$0.00 |
| 3074F |
|
13 |
12 |
$0.00 |
| 90686 |
|
12 |
12 |
$0.00 |