| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,539 |
1,517 |
$90K |
| D1120 |
Prophylaxis - child |
2,901 |
2,876 |
$82K |
| D1110 |
Prophylaxis - adult |
2,567 |
2,550 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,369 |
1,026 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,873 |
2,844 |
$52K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
725 |
687 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,480 |
2,436 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
2,236 |
2,138 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
694 |
532 |
$21K |
| D1206 |
Topical application of fluoride varnish |
5,134 |
5,080 |
$20K |
| D0330 |
Panoramic radiographic image |
768 |
753 |
$17K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
476 |
440 |
$15K |
| D1330 |
|
5,973 |
5,890 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
603 |
436 |
$15K |
| D0190 |
|
848 |
847 |
$13K |
| D0274 |
Bitewings - four radiographic images |
2,417 |
2,385 |
$10K |
| D1351 |
Sealant - per tooth |
1,055 |
341 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
224 |
219 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
143 |
125 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,998 |
2,881 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,797 |
1,002 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
98 |
98 |
$2K |
| D0272 |
Bitewings - two radiographic images |
709 |
699 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
46 |
46 |
$920.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
25 |
$875.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
29 |
29 |
$676.44 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
230 |
226 |
$592.00 |
| D4342 |
|
116 |
47 |
$480.96 |
| D1354 |
|
98 |
25 |
$450.55 |
| 11721 |
|
12 |
12 |
$329.10 |
| 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 |
25 |
15 |
$216.69 |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
231 |
$70.95 |
| 90686 |
|
14 |
12 |
$57.95 |
| 3044F |
|
122 |
118 |
$40.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
14 |
12 |
$18.00 |
| 1000F |
|
1,349 |
1,251 |
$0.00 |
| 2000F |
|
1,416 |
1,307 |
$0.00 |
| 3075F |
|
106 |
102 |
$0.00 |
| 3008F |
|
1,397 |
1,297 |
$0.00 |
| 2001F |
|
1,392 |
1,288 |
$0.00 |
| 3080F |
|
13 |
13 |
$0.00 |
| 3074F |
|
1,032 |
962 |
$0.00 |
| 3079F |
|
319 |
305 |
$0.00 |
| 1220F |
|
1,354 |
1,256 |
$0.00 |
| 36415 |
Collection of venous blood by venipuncture |
163 |
162 |
$0.00 |
| 1125F |
|
288 |
276 |
$0.00 |
| 1126F |
|
710 |
671 |
$0.00 |
| 4000F |
|
62 |
58 |
$0.00 |
| 3078F |
|
820 |
763 |
$0.00 |
| 3077F |
|
41 |
41 |
$0.00 |