| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,908 |
2,740 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
6,012 |
5,974 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,769 |
1,418 |
$112K |
| D1110 |
Prophylaxis - adult |
3,042 |
3,023 |
$111K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,620 |
3,166 |
$97K |
| D0274 |
Bitewings - four radiographic images |
4,406 |
4,384 |
$97K |
| D0330 |
Panoramic radiographic image |
1,629 |
1,623 |
$77K |
| D1120 |
Prophylaxis - child |
1,909 |
1,904 |
$62K |
| H0004 |
Behavioral health counseling and therapy, per 15 minutes |
533 |
258 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,559 |
1,544 |
$37K |
| D1351 |
Sealant - per tooth |
2,163 |
756 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
948 |
682 |
$28K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
377 |
365 |
$24K |
| D9430 |
|
3,248 |
3,079 |
$22K |
| D1206 |
Topical application of fluoride varnish |
4,664 |
4,640 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,606 |
1,595 |
$19K |
| 90834 |
Psychotherapy, 45 minutes with patient |
227 |
103 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
55 |
$6K |
| D1330 |
|
4,779 |
4,755 |
$5K |
| D0272 |
Bitewings - two radiographic images |
2,497 |
2,482 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
82 |
$4K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
83 |
80 |
$4K |
| D9999 |
Unspecified adjunctive procedure, by report |
80 |
80 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
5,967 |
5,904 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
79 |
$2K |
| D1999 |
|
31 |
31 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,482 |
4,389 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
21 |
18 |
$486.21 |
| 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 |
120 |
71 |
$454.29 |
| D0603 |
|
3,180 |
3,156 |
$320.00 |
| D0270 |
|
294 |
292 |
$275.85 |
| D0602 |
|
347 |
343 |
$128.00 |
| 3074F |
|
1,876 |
1,709 |
$88.35 |
| 1126F |
|
3,134 |
2,802 |
$85.09 |
| 81002 |
|
29 |
29 |
$83.95 |
| D0601 |
|
1,795 |
1,792 |
$74.00 |
| 3016F |
|
2,759 |
2,461 |
$37.87 |
| 1158F |
|
2,583 |
2,310 |
$27.63 |
| 1034F |
|
1,215 |
1,096 |
$12.63 |
| 3077F |
|
438 |
412 |
$0.04 |
| 3078F |
|
1,682 |
1,542 |
$0.03 |
| 3288F |
|
782 |
707 |
$0.02 |
| 3075F |
|
392 |
363 |
$0.02 |
| 1125F |
|
758 |
711 |
$0.02 |
| 3079F |
|
680 |
615 |
$0.02 |
| 1159F |
|
3,960 |
3,542 |
$0.00 |
| 1000F |
|
4,233 |
3,782 |
$0.00 |
| 1220F |
|
3,556 |
3,175 |
$0.00 |
| 1036F |
|
3,130 |
2,827 |
$0.00 |
| 3080F |
|
194 |
184 |
$0.00 |
| 36416 |
|
19 |
17 |
$0.00 |
| 1111F |
|
15 |
15 |
$0.00 |